臺灣博碩士論文加值系統

癌症長期是國人十大死因之首，隨著各種治療標準陸續建立，大幅提升存活時間，但癌症發生率卻未因而下降，也因此化療藥物的耗量與藥師調劑工作量居高不下；為提供藥師省力、快速且安全的優良工作環境，並在考量縮短病患等待用藥時間的前提下，本研究首先研究化療調劑工作量之特質以及快速取藥器之物理特質，繼而將其試用來替代傳統針頭於調劑操作量最高的兩藥劑fluorouracil (5-FU)、cisplatin，來進行評估此措施之實施，對北部某醫學中心化療調劑作業效率、調劑藥師本身之身、心之改善與管理效益等指標之改變情形。首先，統計北部某醫學中心96年抗癌針劑藥物調配處方數及化療藥品耗量分析並統計化療藥局藥品耗量，結果顯示門診每月平均處方數為822 ± 86張，住院平均處方數為2267 ± 224張，以抽取藥液之體積來排名則5-FU（平均每日使用瓶數67.5）、cisplatin（平均每日使用瓶數22.7）分別為抽取耗量前2名之藥品。第二部分研究則使用拉力機測試藥品使用傳統針頭抽取時所需最大拉力，並與快速取藥器進行比較，來模擬抽取藥品所需最大拉力。第三部分則由參與試驗的藥師（12人；男5人/女7人；平均年齡為34.1 ± 7.8歲；平均工作年資20.8 ± 37.2個月）測量使用傳統針頭每次抽取30 mL 5-FU藥液量或40 mL cisplatin藥液量，連續12次所需時間，並分別與快速取藥器進行比較；繼而再對受試藥師詢問其上肢酸痛之主觀知覺，評量分數從沒感覺至非常酸痛無法忍耐分別為0~10分，並紀錄其酸痛程度。第四部份則以哥本哈根疲勞量表比較改變取藥器材之對藥師疲勞感知影響。第五部份進行經濟管理效應的推論。結果顯示：以40 cc針筒加上18G針頭抽取5-FU所需最大拉力3.82 ± 0.04 Kg，以快速取藥器抽取藥液則所需最大拉力為0.73 ± 0.20 Kg，具顯著省力效果(p<0.001)；以50 cc針筒加上18G針頭抽取cisplatin藥液所需最大拉力5.96 ± 0.12 Kg，以快速取藥器進行拉力測試則所需最大拉力為1.43 ± 0.37 Kg，具顯著省力效果 (p<0.001)。使用快速取藥器連續抽取12支5-FU較使用傳統針頭節省212.3 ± 95.3秒，同樣抽取cisplatin則可節省375.4 ± 125.4秒，抽取兩藥劑累積時間皆具統計上顯著差異(p<0.001)；進行測試藥師自覺使用快速取藥器抽取5-FU可改善手指及手掌痠痛程度；抽取cisplatin測試組藥師自覺可同時改善手指、手掌、手腕與上臂及肩之痠痛程度。經使用中文版「哥本哈根疲勞量表」(Copenhagen Burnout Inventory，CBI) 檢測「工作相關疲勞」(work-related burnout)指數，結果顯示針頭、快速取藥器CBI分數分別為67.9 ± 19.0 vs 50.4 ± 27.8，具顯著差異(p=0.019)。分析結果顯示使用快速取藥器與傳統純針頭抽取藥液，在愛睏及無力自覺症狀方面眼睛疲勞(p=0.004)，身體局部異常感自覺症狀方面手-肩痛(p=0.008)呈現有意義差異，但在注意力集中困難自覺症狀方面沒有差異。再以計算每日取5-FU或cisplatin兩藥劑調劑瓶數來推算使用快速取藥器可分別節省13.2、29.6分鐘。整體研究結果顯示快速取藥器應用於耗用量高或所需拉力較大之兩藥劑5-FU與cisplatin可縮短藥師調配時間、減少藥師生理疲勞情形；預期可提升整體調劑化療藥物作業流程效率，繼而減少病患候藥時間。

Malignancy is the leading cause of death in Taiwan. The uses and the dispensing of the chemotherapy medicines were also increased. In order to provide energy-saving, efficient and safe working environments and minimize patient waiting time, this study analyze the drug dispensing patterns and characterize the physics of the the tested dispensing device (S; spike®) in the beginning. The impact of this dispensing device application in dispensing anti-neoplastic drugs on the time saving and the physical-psychological parameters of enrolled pharmacists were determined. Results showed that the average number of prescriptions per month was 2267 ± 224 for inpatients and 822 ± 86 for outpatients. According to the consumption volume of anti-neoplasm drugs, fluorouracil (5-FU; 67.5 vials/day) and cisplatin (22.7 vials/day) were the highest-dispensing agents. Well-trained dispensing pharmacists (n=12, M/F=5/7, average age: 34.1 ± 7.8, work experience 20.8 ± 37.2 months) was included. Soreness of upper limb muscle soreness of upper limb muscle with visual analog pain scale (0 is none, 10 cannot endure), and physical fatigue state from the “work-related burnout” of the Chinese version of Copenhagen Burnout Inventory (C-CBI) was also measured for pharmacists (n=10). The results reveal that pulling force required for 5-FU or cisplatin withdrawl by using syringe-needle (18G) is 3.82+/-0.04 Kg, 5.96+/-0.12 Kg and only 0.73+/-0.2 Kg, 1.43+/-0.37 Kg is needed when using new medical device-S significantly decreased the accumulated dispensing time in withdrawing 30 mL 5-FU or 40 mL cisplatin repetitively twelve times by 212.3 ± 95.3 seconds, 375.4 ± 125.4 seconds, compared to the ones using traditional needle (p<0.001). The soreness of muscle of upper limb reported by pharmacists especially in finger and palm regions were also improved for 5-FU and in finger, palm, wrists and shoulder. Results of reported burnout score showed that replacing the needle by the new medical device-S significantly improved the score from 67.86 ± 19.05 to 50.36 ± 27.84 (p=0.019). Compared to using needle in dispensing agents, application of the medical device significantly improved eyestrain (p=0.004) and musculoskeletal discomfort (p= 0.008). Overall time-saving for 5-FU or cisplatin was 13.2 and 29.6 mins per day. Conclusions: Application of a new medical device (spike®) in 5-FU or cisplatin dispensing process shortened the dispensing time and improved efficiency of filling chemotherapy prescriptions, scores of muscle soreness and working-burnout indicators. The goal of improving pharmacy dispensing procesure may be optimized and further decrease patient’s waiting time.

目次 I
中文摘要 Ⅲ
英文摘要 Ⅳ
第一章、緒論 1
第一節、研究背景 2
第一項、抗癌藥物調劑作業準則 2
第二項、國內相關法規 2
第二節、研究目的 3
第三節、選擇研究對象及理由 4
第二章、文獻探討 5
第一節、癌症流行病學與疾病治療 6
第二節、調劑化療藥物面臨問題 7
第三節、改善化療藥物調劑流程之相關研究 8
第四節、肌肉酸痛 9
第五節、疲勞測定 10
第三章、研究設計 11
第一節、研究材料來源與研究對象條件 12
第二節、試驗步驟及方法 13
第三節、資料分析與統計分析 15
第四章、結果 16
第五章、討論 23
第六章、結論 29
第七章、圖表及附錄說明 31
Table 1. Demographic and basal characteristics of pharmacists 32
Table 2. Demographic and basal characteristics of pharmacists for fatigue trial. 33
Table 3. Maximum pulling forces required for withdrawing Cisplatin & Fluorouracil by using Spike® or needle. 34
Table 4. Time spent in dispensing 5-FU、cisplatin using Spike® or needle 35
Table 5. Muscle soreness test 36
Table 6. CBI-work related burnout questionnaire test 37
Table 7. Fatigue syndromes reported by pharmacists using Spike or
needles for chemotherapy dispensing 38
圖一、試驗藥品5-FU 39
圖二、試驗藥品cisplatin 40
圖三、快速取藥器 41
圖四、試驗用18G針頭 42
圖五、試驗用針筒 43
圖六、拉力機 44
圖七、96年化療藥局門住診處方數/總筆數
45
圖八、96年化療藥局藥品耗量統計圖 46
圖九、使用傳統18 G針頭抽取Cisplatin藥液所
需拉力之曲線圖 47
圖十、使用快速取藥器抽取Cisplatin藥液所需拉力之曲線圖 48
圖十一、使用傳統18 G針頭抽取5-FU藥液所需拉力之曲線 49
圖十二、使用快速取藥器抽取5-FU藥液所需拉力之曲線圖 50
圖十三、分別使用快速取藥器與傳統針頭18 G連續抽取
12支30毫升之Cisplatin所累積的時間 51
圖十四、分別使用快速取藥器與傳統針頭18G連續抽取
12支40毫升之5-FU所累積的時間 52
圖十五、快速取藥器外加軟管圖 53
附表一、哥本哈根疲勞量表Copenhagen Burnout Inventory CBI）之工
作疲累測試問卷 54
附表二、自覺疲勞症狀調查表 55
參考文獻 56

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