畢業後一般醫學住院醫師參與長期照護用藥安全之學習模式

目的：針對社區導向基層醫療的訓練課程，某醫院社區醫學教學小組邀集長照與藥事服務團隊，嘗試建立住院醫師參與長期照護用藥安全的學習模式，並評估學習成效。方法：某醫院社區醫學教學小組規劃每週半天、連續四週的長期照護課程，安排養護機構與社區藥局為學習場所，並設計藥事服務需求評估單。由長照藥事服務團隊與住院醫師共同討論管灌用藥、特殊用藥、交互作用與副作用。再依據評估結果，提供衛教諮詢，建立用藥安全護照。住院醫師在學習前後，以Likert 5分法，自評「能夠對長期照護的病情、藥物使用做初步評估」的熟悉程度，再以paired t test 比較學習前後的差異。結果：2006年11月至2007年2月，共有25位住院醫師參與某醫院長照藥事服務團隊，評估118位長照病患的藥事服務需求，其中男性病患47位，女性71位，平均年齡80.0(±11.5)歲。日常生活完全依賴他人者71位，部分依賴他人者35位。使用鼻胃管者57位，需要至少二種導管照護者19位。服藥完全依賴他人者70位，部分依賴他人者22位。針對藥事服務需求評估，長照藥事服務團隊指導住院醫師完成96本用藥安全護照。住院醫師(n=25)在訓練前，自評學習項目「能夠對長期照護的病情、藥物使用做初步評估」的熟悉程度為2.52(±1.05)分，訓練後自評熟悉程度為3.88(±0.83)分，呈顯著差異（p值＜.0001）。結論：本報告評估的長期照護個案病情複雜程度不同，且個案數有限；因此，僅著重於以需求評估與用藥衛教的實例，建立住院醫師參與「長期照護用藥安全」的學習模式。未來仍需針對「藥事服務需求評估表單」，做更嚴謹的信度效度檢測。期待未來社區長期照護的實務課程規劃，能夠針對實地需求評估，擬定長期照護的個案管理方案，包括用藥安全護照建檔，共同提升長期照護病人的用藥安全。

關鍵字

畢業後一般醫學訓練；長期照護；用藥安全；藥事照護

並列摘要

Background and purpose: With the learning aim of community medicine training in the postgraduate year (PGY) residency program, the directors designed a course on ”drug safety for long-term care”, and invited PGY residents to participate in integrated long-term care. Methods: The PGY teaching group developed a schedule to assess the needs of the pharmaceutical care for inhabitants of long-term care facilities. The assessment schedule consisted of 5 items: medication dependency, medication side effects, administered at least 8 prescriptions, medication monitoring, and special medications. Initially, the high-risk people were evaluated, and the results were recorded on their drug safety passports. PGY residents self-assessed the acquaintances of the learning item, ”ability to assess the state of health and medications for long-term care” from a score of 1 (very low) to a score of 5 (very high). Paired t test were used to compare the differences of scores self-assessed by PGY residents before and after the training. Results: From Nov 2006 to Feb 2007, 25 PGY residents were accompanied by the long-term care team to assess the integrated care and drug safety for 118 inhabitants, 47 males and 71 females, with a mean age of 80.0 (±11.5) years old. In daily living activities, 71 were completely dependent, and 35 were partially dependent. A nasogastric tube was inserted into 57.70 were completely dependent for administering medications. According to the needs of the pharmaceutical care, the long-term care team discussed with the PGY residents the drug interaction, and completed a drug safety passport for 96 inhabitants. PGY residents (n=25) self-assessed the acquaintances of ”ability to assess the state of health and medications for long-term care” were 2.52 (±1.05) scored before training, and 3.88 (±0.83) scored after training. Comparing the results before and after the training, it revealed significant differences (p＜.0001). Conclusion: The long-term care team designed a short questionnaire to assess the needs of the pharmaceutical care, with the aim of providing drug safety for the inhabitants and a teaching model for the PGY residents. PGY residents may play a role of communicators in the practice course, and develop patient safety in long-term care facilities. However, it is necessary to design a precise schedule to assess the learning effect of PGY residents.

並列關鍵字

postgraduate year residency ； drug safety ； long-term care ； pharmaceutical care

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畢業後一般醫學住院醫師參與長期照護用藥安全之學習模式

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