探討護理師使用條碼科技給藥之經驗

給藥安全是全球所追求的目標。為預防給藥錯誤，國內外醫院也陸續採用條碼給藥物系統（BCMA）來維護病人的用藥安全，雖有學者探討護理師使用條碼給藥降低給藥錯誤的成效，但文獻中鮮少提及在轉換條碼給藥時護理師的心境歷程、條碼給藥的實用性及所附帶效益的困擾。故本研究目的在探討護理師使用條碼給藥之經驗，採「立意取樣」的方式選取對象，於2018年3月至5月，在北部某醫院選取12位使用過條碼給藥系統給藥，並持有護理師證書，大於等於20歲，且醫院服務大於一年為研究對象。運用深度訪談方式收集資料，以詮釋現象學分析步驟分析、整理及歸納出由五個主題及十三個次主題所構成的護理師使用條碼技術給藥經驗。主題及次主題分別：主題一、轉換使用的茫與忙，分成三個次主題：「學校實習教育的扎根」、「醫院訓練的再精進」、「新舊技術轉換時的繁瑣流程」；主題二、工善其事，必先利其器，分成三次主題：「影響安全的給藥步驟與順序」、「造成護理師給藥錯誤的訊息」、「條碼系統無法應付突發狀況」；主題三、避免跡近錯誤：分成三個次主題：「雙重覆核藥物正確性」、「藥物圖片辨識正確的藥物」、「提醒給藥時間正確性」；主題四、三讀五對仍為給藥核心，分成二個次主題：「條碼給藥無法替代藥物「五對」」、「未刷條碼給錯藥」；主題五、強化護病關係，分成二個次主題：「條碼給藥給予正確藥物指導」、「強化護理專業行為」。根據本研究發現，藉由護理師親身經歷並藉由口說的現象能更深入了解護理師從護生開始條碼技術學習的教育訓練是否擬真於臨床現實狀況，讓護理師更熟悉操作使用方法來降低傳統與科技轉換過程及科技設計的衝擊所產生的忙與茫的感覺；但另一方面也看見護理師運用了科技所帶來的優勢去提升專業自信與護病關係的轉變。故本研究結果可提供後續醫療機構建置條碼給藥系統的借鏡、建立安全文化的環境、降低給藥錯誤的發生。

關鍵字

護理師；條碼給藥使用經驗:質性研究

並列摘要

The topic of drug safety is the goal pursued globally. In order to prevent administration errors, Bar Code Medication Administration (BCMA) has been used to enhance patients safety. Although some scholars have explored the effectiveness of BCMA to reduce administration errors, little in known regard nurse’s experience of use BCMA and the barriers and benefits of BCMA during the transition time form traditional paper documentation to the in collaboration of technology. Therefore, the purpose of this study was to explore the experience of the nurses using BCMA, and purposefully select participants who have the experience use BCMA. From March to May 2018, 12 nurses who worked in community teaching in Northern Taiwan, hold a registered nurse license, age 20 years old and above, and worked longer than one year were enrolled. We had in-depth face to face interviews to collect data, and use Colaizzi’s (1978) interpretation of phenomenological analysis steps to analyze the date. Then were five themes and thirteen sub-themes. Themes one ‘Busy and Overwhelm’ and three sub-themes, including ‘the foundation form school education’, ‘re-training of BCMA the hospital’, and ‘the complex process during tradition to new technology’; Themes two ‘ if you are good at it, you must first sharpen it’, and three sub-themes, including ‘the steps and sequence of administration that affect safety’, ‘the message that causes the nurses to medication error’, and ‘BCMA can’t cope with unexpected situations’; Themes three ‘avoid near-error’ and three sub-themes, including ‘Double-checking medication safe’, ‘ medication picture correct medication’, ‘correct medication time sequence’; Themes four ‘Three readings and the Five rights of medication administration still be core’ and two sub-themes, including ‘BCMA can not replace the Five rights of medication administration’, ‘Unbrushed BCMA give wrong medication’; Themes five ‘strengthen the relationship between patient protection’ and two sub-themes, including ‘BCMA gives correct medication guidance’, ‘Strengthen the professional behavior of nurses’. According to the findings of this study, through the phenomenon experienced by the nurses and through the mouth speaking phenomenon, it is possible to have a deeper understanding of whether the education training of the nurses starting from the BCMA technology learning from the nurses students is true to the clinical reality, so that the nurses are more familiar with the operation methods. To reduce the feeling of busyness and overwhelm caused by the impact of traditional and technological conversion processes and technological design; on the other , it has also seen that the nurses have used the advantages brought by technology to enhance the transformation of professional confidence and disease protection. Therefore, the results of this study can provide a follow-up medical machine to build a bar code delivery system to borrow a mirror, establish a safe culture environment, and reduce the occurrence of medication errors.