探討藥師於長期照護機構用藥安全管理品質之成效 -以北部某區域教學醫院之合作機構為例

Outcomes Evaluation of the Pharmacist Intervention on the Quality of Medication Safety and Management in Long-Term Care Facilities - A Collaboration between A Regional Teaching Hospital in Northern Taiwan with Two Institutes

黃煒婷(Wei-Ting Huang)

指導教授 ： 譚延輝

高雄醫學大學/藥學院/藥學系碩士在職專班/碩士(2018年)

摘要

根據內政部統計，台灣於民國107年3月正式進入「高齡社會」，老年人口(≧65歲)佔全人口14.05%，老化指數（老年人口/幼年人口*100%）達107.4。長照機構數由104年的1,067間上升至106年的1,100間，可照顧老年人口數/需長照之失能老年人口數達到27.98%。機構中住民用藥較多且複雜，但目前於用藥上重視程度不高，雖有強調藥物治療評估，但很少探討全機構提供用藥安全管理。故本研究利用中華民國藥師公會全聯會長照機構藥事服務之「長照機構用藥安全管理品質評估表」，先對評估表進行信效度檢測後，實際於二機構進行評估，每次評估後給予建議並勸導改善。分別進行三次評估後，比較藥師介入前後差異。
此評估表專家效度高達0.99；評分者一致性信度，經修改評分方式與新增評分標準後，CVI值由0.625上升至0.890，具高度信度。藥師介入後，機構一進步9.87%，p=0.008;機構二進步32.00%，p=0.003，皆<0.01，具高度顯著性。由結果可知，藥師利用評估表提出建議，經由機構醫療團隊支持與配合，可有效改善機構用藥品質。本研究也修正此評估表的評分方法以提升正確性。此評估表能反映長照機構用藥安全管理品質實際情形，可做為品質持續精進很好的測量工具。
本研究進一步運用專家意見、實際評估發現與現行各長照機構評鑑條文，對評估表提出改善建議，由2大層面、18面向、評估題目共58題修改為3大層面、18面向、共65題題目，期能提供更完整評估表，幫助藥師能快速且完整審視機構整體用藥管理狀況。本研究並參考美國機構評鑑藥師方式，建置「長照機構藥師服務品質評估表」，可做為將來對藥師在機構進行藥事專業服務之品質評估的參考。

關鍵字

藥師 ； 長照機構 ； 用藥安全管理 ； 高品質用藥

並列摘要

According to statistics of the Ministry of the Interior, Taiwan officially entered the “aged society” in March 2018, with the elderly/total population ratio of 14.05%, and Aging Index (elderly/children population*100%) reaching 107.4. Numer of long-term care institutions increased from 1,067 in 2015 to 1,100 in 2017, with the accommodated elderly/disabled elderly requiring long-term care reaching 27.98%. Medication use by admitted residents were complex and with varieties, but there is little emphasis on medication use safty management at present. Despite the emphasis on drug regimen review, the discussion of policy and procedure on safe medication use process and management by the institutions remain scarce. Therefore, this study adopted the “Assessment tool on the quality of medication safety and management in Long-term Care Facilities” established by Taiwan Pharmacist Association for the pharmaceutical services in long-term care institutions. After carrying out the reliability and validity tests on the assessment tool, two institutions were evaluated. Recommendations were provided after each assessment to exhort improvement. After three assessment sessions, differences before and after the intervention of pharmacists were compared.
The expert validity of the assessment tool reached 0.99. As for the consistency reliability after revising the scoring method and adding scoring criteria, the CVI value increased from 0.625 to 0.890, indicating high reliability. After the pharmacist interventions, Institution 1 improved by 9.87%, p=0.008 and Institution 2 improved by 32%, p=0.003, indicating high significance of changes. The results showed that the pharmacist recommendations based on the assessment tool and the support and cooperation of the institutions’ medical teams effectively improved the quality of medication use process and management in the institutions. The study amended the scoring method of the assessment tool to increase its accuracy. Also, the assessment tool truly reflects the actual situations of the quality of medication use and management in long-term care institutions, which is considered a sound measurement tool for continuous quality improvement.
This study further proposed a revised version of the assessment tool based on expert opinions, actual assessment findings, and existing long-term care institution accreditation criteria. The 2 aspects, 18 dimensions, and 58 assessment questions were changed into 3 aspects, 18 dimensions, and 65 questions, in the hopes of providing a more comprehensive assessment to help pharmacists promptly and completely examine the medication use process and management situations in the institutions. Finally, this study, with references to accrediatation methods used in the United States to evaluate pharmacists performance, suggested an “Assessment form for the quality of pharmacist services in Long-Term Care Facilities”, which shall serve as a reference for pharmacists in institutions to carry out the quality assessments of pharmacy professional services in the future.

並列關鍵字

Pharmacists ； Long-term care institutions ； Medication safety management ； Quality use of medicines

參考文獻

英文部分

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ASCP. (1999). Guidelines for assessing the quality of drug regimen review in long-term care facilities. Retrieved from http://www.ascp.com/member/policy/guidelines/1999/drrqu.

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