某區域教學醫院門診處方之評估

Assessment of Outpatient Prescriptions in a Teaching Hospital

紀政良(Chi Cheng Lain)

指導教授 ： 許光陽 ； 簡淑真

臺北醫學大學/藥學院/藥學研究所/碩士(1999年)

摘要

中 文 摘 要 藥師依據醫師處方，了解其治療用意、判斷處方藥物是否適當，發揮“制衡”的功能，是藥師基本的職責之一。本研究的目的在了解一區域教學醫院，藥師憑藉門診處方箋的內容評估處方，會發現的問題處方種類、數量及出現的頻率。本研究選取民國八十六年十一月二十二至二十八日（樣本一）及八十七年五月十八至二十三日（樣本二），二週之門診處方箋，排除出院病人、疫苗注射、檢查用藥及牙科、急診等處方，做一回顧性的評估，評估的項目共有14項，分為三大類：(A) 處方書寫問題 (B) 藥物治療適當性問題 (C) 處方完整性問題。本研究總計審查10,151張處方箋，共42,852筆處方用藥，平均每張處方用藥筆數約為4.2筆。處方書寫問題︰樣本一及樣本二發生率分別為0.44%及0.38%；藥物治療適當性問題︰樣本一及樣本二發生率分別為2.27%及1.86%; 在藥物治療適當性問題處方問題中，佔最多數的是處方藥品之適應症與處方箋上記載之診斷疾病不符合 (樣本一有228筆，發生率約為1.02%; 樣本二有159筆，發生率約為0.77%)；其次為後果嚴重程度較高的藥物交互作用 (樣本一有128筆，發生率約為0.57%; 樣本二有92筆，發生率約為0.45%) ﹔最後，所有被評估的處方中約有八成的處方箋有一個以上不完整之處，其中大部分 (96.70%) 是缺少疾病名稱。根據本研究的結果，約有百分之二的門診處方之藥物治療適當性有問題，對病人有潛在性的危險。藥師應增加對不適當處方的警覺性，還有與病人、醫師的溝通時間，以減少各種不適當門診處方可能對病人產生的危險。

關鍵字

門診處方 ； 藥師的職責 ； 藥物交互作用

並列摘要

Abstract When dispensing, assessing the appropriateness of prescription is one of the most important responsibility of pharmacist for the purpose of "Check and Balance". The objective of this study is to inspect the occurrence and frequency of inappropriate prescriptions in the outpatient setting of a teaching hospital. The outpatient prescriptions from November 22nd to 28th in 1997 (Sample 1) and May 18th to 23rd in 1998 (Sample 2) were retrospectively reviewed. Prescriptions for discharg, vaccine injections, clinical examinations, and prescription from dental and emergency service were excluded. Fourteen items for appropriateness assessment are classified into three categories: (A) prescription writing problems; (B) appropriateness of pharmacotherapy; (C) prescription completeness. In total, 10,151 prescription profiles and 42,582 prescriptions were reviewed. Incidence rate of prescription writing problems: Sample 1 = 0.44% and Sample 2 = 0.38% and inappropriateness of pharmacotherapy : Sample 1 = 2.27% and Sample 2 = 1.86%. Of problems relating to the appropriateness of pharmacotherapy prescribed, drugs whose medications did not match the medical diagnoses noted on prescriptions was the most frequently identified in this study (Sample 1: N = 228, 1.02%; Sample 2: N = 159, 0.77%). Drug interaction was the second common problem (Sample 1: N = 128, 0.57%; Sample 2: N = 92, 0.45%). Approximately 83% of prescriptions was found incomplete, mostly because only codes for diagnoses, but not the full names, were written out on prescriptions (96.70%). Overall, there were approximately two percent of medications prescribed would potentially cause harm to patient. Therefore, pharmacists should be more aware of the occurrence of any inappropriate prescriptions, as well as communicate to clinicians with an effort to minimize the occurrence of inappropriate prescriptions.

參考文獻

17. 行政院衛生署: 優良調劑作業規範1995.3.8.

1. J.A. Vitillo, T.S. Lesar. Preventing Medication Prescribing Errors. The Annals of Pharmacotherapy, 1991;25:1388-1394.

3. C.J. Hawkey, S. Hodgson, A. Norman, T.K. Darneshmend, S.T. Garner. Effect of Reactive Pharmacy Intervention on Quality of Hospital Prescribing. British Medical Journal 1990;300:986-90

4. T.S. Lesar, L.L. Bricel, K. Delcoure, J.C. Parmalee, V. Masta-Gornic, H. Pohl. Medication Prescribing Errors in a Teaching Hospital. Journal of American Medical Association, 1990;263:2329-2334.

6. T. S. Lesar, L. L. Briceland, D. S. Stein., Factors Related to Errors in Medication Prescribing, Journal of American Medical Association, 1997;277:312-317.