住院處方失誤網路通報系統之建置

Establishment of a Web-based Pharmacy Reporting System for In-patient Prescribing Errors

何蘊芳(Yunn-Fang Ho) ； 吳如琇(Ru-Shu Wu) ； 林慧玲(Fe-Lin Lin Wu) ； 楊蕙圓(Huei-Yuan Yang) ； 孫美寶(Mei-Po Suen) ； 陳文慧(Wen-Hwei Chen) ； 謝玲玲(Ling-Ling Hsieh) ； 黃甄彥(Chen-Yen Huang) ； 陳燕惠(Yen-Hui Chen)

《台灣醫學》 9卷4期 (2005/07) Pp. 439-447

https://doi.org/10.6320/FJM.2005.9(4).01

摘要

開方失誤(Prescribing error)乃醫藥失誤(medication error)產生的重要環節之一，此種失誤常經由專業執業藥師偵測並加以適當處理而及時防止。本研究探討醫學中心藥劑部門透過建置開方失誤網路通報作業系統，使得藥師於部內網頁得以即時逐筆線上登錄住院處方問題的成效，除就問題別做敘述性統計外，並進一步依據問題類型、開方科部、及藥劑部門各住院調劑單位所通報失誤量做分析，期以對醫學中心住院醫療服務之開方失誤問題加以瞭解。在九十二年七月至九十三年六月的一年研究期間，所通報之開方失誤量達33,426筆，佔總開方筆數1.98%，通報比例最多之處方問題依類型別、開方科部別、調劑單位別，分別以鍵入錯誤(70.4%)、內科部(43.3%)、總院東址住院藥局(87.0%)等項次或單位居冠，後兩者亦大致反應了其業務量及編制。整體而言，醫師對藥師所提處方建議之平均接受率達93.5%，如就各處方問題別細部探討，發現以「未在電腦取消應停藥醫囑」之18,783筆(56.2%)為最常見，且此項問題之建議接受率達99.8%，顯示醫院營運效益之提昇仍有極大空間；而接受率最不理想的項目為「出院藥與非碳寫複本不符」(26.3%)，改善方式應可朝加強醫藥溝通、舉辦專業人員教育宣導、及調整機構開方政策等方向進行。

關鍵字

開方失誤 ； 住院 ； 藥事資訊系統

並列摘要

Prescribing error is considered the key link in the occurrence of medication errors. These kinds of errors may often be detected and prevented by the pharmacy profession. By establishing a computer network reporting system in the pharmacy of a medical center, pharmacists are rendered able to key in on the intranet webpage all prescription errors they have detected from their sites of practice. This report aims to document the effect of the implementation of the computer network reporting system. Besides the descriptive analysis of the types of prescription errors, we further analyze the errors according to the types of errors, prescribing departments, and the amount of reported errors in each pharmacy divisions, in the hope to further understand the causes of this type of errors. Between July, 2003 and June, 2004, a total of 33,426 medication orders (1.98% of total prescription orders) were reported to be problematic. The most frequent errors according to the types of errors, prescribing departments, and dispensing departments, are computer entry errors (70.4%), department of internal medicine (43.3%) and inpatient pharmacy of the East wing of NTUH (87.0%), respectively. The latter two percentages basically reflect the amount of service. The physicians' acceptance rate for the pharmacist's intervention on the average reaches 93.5%. To look into this further, ”failure to discontinue the order on the computer” is the number one reason for pharmacist's intervention (18,783 orders, 56.2%) on the list, and the acceptance rate of doctors is also high (99.8%). This may imply that there's still room for improvement in terms of the efficiency of hospital management The least accepted intervention was ”inconsistency between computerized and written versions of discharge medication orders” (26.3%), efforts should be aimed at improving the communication between physicians and pharmacists, education campaigns for medical and pharmacy professionals, as well as adjustment of prescribing policies.

並列關鍵字

in-patient ； prescription errors ； pharmacoinformatics