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研究生:楊瑛碧
研究生(外文):Ying Pi Yang
論文名稱:某區域醫院不良處方類型與藥事照護介入成果分析
論文名稱(外文):Analysis of Inappropriate Prescriptions and Outcomes of Pharmaceutical Intervention in a Regional Hospital
指導教授:王惠玄王惠玄引用關係
指導教授(外文):H. I. Wang
學位類別:碩士
校院名稱:長庚大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
論文頁數:77
中文關鍵詞:處方疏失用藥疏失藥事照護病人安全
外文關鍵詞:prescribing errorsmedication errorspharmaceutical carepatient safety
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處方疏失是用藥疏失產生的重要環節之ㄧ。本研究目的在於探討藥師介入醫師處方審核是否發揮其專業,防止『藥品治療問題』之發生,並分析醫師不良處方類型、藥師建議處置方式、藥師介入結果;及處方調整前後之藥費差異。

資料來源為北部某區域教學醫院95年1月至97年12月三年間藥師專業服務案例紀錄,包含病人性別、年齡、診療處所、醫療科別、藥物治療問題、藥師建議、介入結果、及處方金額等。

總計有5533件紀錄,介入率佔總處方數的0.08%;半數以上(55.28%)為內科醫療處方;住院病人、高齡者佔了多數的通報案例。不同院區、診療科別、診療處所、病患年齡的主要藥物治療問題分佈有差異,但整體而言以重複用藥最常見。藥師介入建議以向原處方醫師確認為最多(28.57%),其次依序為停用某藥(18.38%),改變劑量(17.71%),及更改藥品數量(11.51%)。藥師介入結果以停用某藥比例最高(25.61%),其次依序為改變劑量(20.31%)、換用其他藥品(14.4%)及更改藥品數量(13.77%)最多。藥師介入處方前後藥費差異,平均每張處方可節省231.72元。

本研究發現藥師執行藥事照護審核醫師處方,確實發掘不少藥物治療問題,提出具體建議,並獲得醫師良好的接納,發揮藥師專業,也節省可觀的藥物浪費。建議醫療機構與衛生行政主管機構建立具體制度,賦予藥師於醫療服務團隊中更積極主動的角色與功能,以提升病人安全並避免浪費。
“ Prescribing errors” is one of the important factors in constituting “Medication errors”. The purpose of this study is to probe and discuss if pharmacist is developing his professional skill while involving the scrutinization of the doctors’ prescriptions, preventing the occurrence of medication problem and to analyze the type of doctors’ bad prescriptions, the suggested way of handling such kind of prescriptions, the results of pharmacists’ intervention; the difference of medication charge between before and after the adjustment of prescriptions.
The data materials were sourced from a regional teaching hospital in the northern part of Taiwan, starting from Jan 2006 to Dec 2008, collecting the records of service cases offered by pharmacists including the sex, age, location of medication, classification of medications, therapeutical problem by medications, pharmacist’s suggestions, the result of intervention, the amount of prescription, etc.
There are totally 5533 cases of record, the rate of intervention accounts for 0.08% of the total number of prescription. Half of them (55.28%) are for internal medicine, the hospitalized patients and the aged patients accounts for the majority of the reported cases. There are existing differences in the distribution of major medication problems based on different hospital sector, different department of medication, different location of medication, different patient age. But to speak as a whole, duplicate medication is the most frequent problem. Among the pharmacist intervention by suggestion, to check the doctor who prescribed the prescription contributes the largest portion (28.57%). Next to it is the termination of medication for certain medicine (18.38%), then comes the dosage modification (17.71%), then followed by the revision of medicine quantity (11.51%). Among the results of pharmacist intervention, termination of a certain medicine accounts for the largest proportion (25.61%), which is followed by the dosage modification(20.31%), then by the replacement with other medicine (14.4%), then by the change of medicine quantity (13.77%). The average saving between before and after the pharmacist intervention is NT$231.72 by each prescription.
In this study, we found that the pharmaceutical care and the scrutinization of physician’s prescriptions rendered by pharmacist do discover a lot of medication problems, proposing concrete suggestions, and well acceptance by the physicians was achieved, the pharmacist profession was fully developed, and a significant saving from medication waste was also achieved. We would suggest that the medication organization and the health administration organization build up a concrete system to bestow upon pharmacists a more positive and active role and function in the medication service team to elevate the safty for the patients and to avoid waste.
目 錄
指導教授推薦書
口試委員會審定書
碩博士論文授權書..........................................iii
長庚大學碩博士紙本論文著作授權書............................iv
誌謝.....................................................v
中文摘要.................................................vi
英文摘要.................................................vii
目錄....................................................ix
表目錄..................................................xi
圖目錄..................................................xii
第一章 緒論.............................................1
第一節 研究動機及背景....................................1
第二節 研究目的.........................................3
第三節 預期貢獻.........................................4
第二章 文獻探討.........................................5
第一節 用藥疏失.........................................5
第二節 不良處方.........................................7
第三節 藥師專業判斷服務..................................9
第三章 研究設計...........................................11
第一節 資料來源...........................................11
第二節 個案醫院專業判斷服務編碼系統.......................11
第三節 統計與分析方法...................................13
第四章 結果與討論.........................................15
第一節 通報案主臨床照護特性分析..........................15
第二節 通報案件數依院區之分佈分析........................17
第三節 通報案主人口學特性分析............................18
第四節 不良處方類型分析.................................19
第五節 不良處方建議處置分析..............................31
第六節 不良處方建議結果分析..............................43
第七節 藥事專業服務介入處方前後藥物費用差異分析............56
第五章 結論與建議.........................................57
第一節 結論............................................57
第二節 建議............................................58
第三節 限制............................................59
參考文獻.................................................61
附錄一 藥師專業判斷性服務記錄表............................63
附錄二 藥師專業判斷性服務編碼表............................64


表目錄
表一 處方介入通報案件依部科別分析........................16
表二 通報案件數依通報地點別之分析........................17
表三 通報案件數依院區之分佈.............................18
表四 通報案主人口學特性分析.............................18
表五 通報案件數依『藥品治療問題(AA)』分析................20
表六 前五大發現藥物治療細項問題(AA)依院區別分析...........22
表七 前五大發現藥物治療細項問題(AA)依部科別分析...........25
表八 前五大發現藥物治療細項問題(AA)依地點分析.............27
表九 前五大發現藥物治療細項問題(AA)依年齡分析.............30
表十 通報案件數依『藥師介入建議(BB)』分析................31
表十一 藥師介入活動(BB)依院區別分析.......................33
表十二 藥師介入活動(BB)依部科別分析.......................36
表十三 藥師介入活動(BB)依通報地點分析.....................39
表十四 藥師介入活動(BB)依年齡別分析.......................42
表十五 通報案件數依『藥師介入結果(CC)』分析................43
表十六 藥師介入結果(CC)依院區別分析.......................46
表十七 藥師介入結果(CC)依部科別分析.......................49
表十八 藥師介入結果(CC)依通報地點分析.....................52
表十九 藥師介入結果(CC)依年齡別分析.......................55
表二十 藥事服務介入處方前後藥費差異分析....................56

圖目錄
圖一 醫師處方疏失『劑量過高』實證.........................65
圖二 個案醫院門診醫師處方箋錯誤率.........................65
圖三 藥師專業判斷性服務作業流程圖.........................66
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