接受腸道營養治療之住院病患經由鼻胃管投予藥物時之潛在用藥安全性風險評估

目前接受腸道營養治療之灌食病患並未有其專用之內服液劑藥物劑型，而大都是將一般口服固體劑型藥物改變後經由餵管灌食投予，但此可能潛藏著各種不同程度的用藥安全性風險問題；且若將藥物與營養液混合灌食時，亦可能產生不易預測之效果與配伍禁忌。使用不適當的管灌方法經由餵管投予藥物將可能導致餵管阻塞、毒性增加或療效降低，進而增加醫院之醫療成本。本研究於某一區域教學醫院中，選取 2004年 1 月至 12 月中經由鼻胃管灌食接受腸道營養治療之住院病患合計 875人次的所有電子檔用藥紀錄，共 25,680 筆藥物。針對接受腸道營養並經由鼻胃管投予藥物所可能產生之潛在用藥安全性風險問題做一回顧性評估調查研究。評估的問題類別共有 6 項：（1）藥劑學性配伍禁忌，（2）應教導特殊管灌方法，（3）餵管阻塞，（4）與聚氯乙烯餵管壁材質之吸附作用，（5）藥物與營養配方液之交互作用，（6）危害醫護人員之風險。研究結果發現這群管灌病人的口服劑型治療藥物中具潛在用藥安全性風險問題的件數為 1,876 件；整體平均盛行率為 7.3 %，其中依風險問題評估類別、病房別、科別、疾病主診斷別、藥理作用類別之各項統計分析結果，分別佔居最高盛行率者為：藥劑學性配伍禁忌之盛行率為 4.7 %；一般病房之盛行率為4.3 %；胸腔內科之盛行率為 2.5 %；急性呼吸衰竭之盛行率為 3.0 %；瀉劑及緩瀉劑類之盛行率為 1.6 %。經由鼻胃管接受腸道營養之灌食病人，大都屬病情危急且用藥複雜性高，這群病人之用藥安全迫切需要相關醫療人員與有關單位之重視。

關鍵字

用藥安全；管灌餵食；腸道營養

並列摘要

Currently, there is no commercially available oral dosage form for tube feeding patients, it has the potential to cause undesirable effects or incompatibilities when instead of taking ordinary dosage orally by crushing destroys to via tube feeding administration and combined with enteral feeding formulas; however, tube obstruction, increased toxicity, or reduced efficacy may occur if an improper administration method is used. Then, it may increase medical costs of hospital. The purpose of this study was to survey medical safety risk prevalence for inpatient that received enteral nutrition through medication with nasogastric tube feeding. To collect all drug profiles for all inpatients who have received enteral nutritions and medications with nasogastric tube feeding in a regional teaching hospital between Jan. to Dec. in 2004. It included 875 patients with 25,680 medication contents for evaluation, and makes a review of assessment of prescriptions. The categories of evaluation were: (1) pharmaceutical incompatibilities, (2) special medication via feeding tube, (3) clogged feeding tube, (4) PVC adsorption with medication, (5) drug- nutrient interactions, and (6) the risks of dangers to medical personnel. This study discovered that total amount of potential medication safety risks was 1,876 and the overall prevalence was 7.3%. The items of results depending on categorizes of evaluation, ward, medical specialty, diagnosis and pharmacology were as follows: The highest prevalence is pharmaceutical incompatibilities which is 4.7%. The highest prevalence was general ward which is 4.3%. The highest prevalence was pulmonary disease which is 2.5%. The highest prevalence was acute respiratory failure which is 3.0%. The highest prevalence was cathartics and laxatives which is 1.6%. Most inpatients using enteral tube feeding are critical and medication complexities. The medication safety for those patients is urgent and need to be emphasized.

並列關鍵字

medication safety ； tube feeding ； enteral nutrition

參考文獻

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