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研究生:黃培培
研究生(外文):Pei-Pei Huang
論文名稱:以藥物一致性流程探討藥物疏失與不良事件
論文名稱(外文):A study of medication error and adverse drug event
指導教授:郎慧珠郎慧珠引用關係
指導教授(外文):Hui-Chu Lang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫務管理研究所
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
語文別:中文
論文頁數:117
中文關鍵詞:藥物疏失藥物一致性流程處方差異藥物不良事件
外文關鍵詞:Medication errorsMedication reconciliation processDiscrepancyAdverse drug events
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研究背景:根據美國醫療機構評鑑聯合會醫療不良事件統計,藥物疏失是造成病患死亡或重大傷害的重要原因,63%都是起因於溝通不良,而其中半數可藉由藥物一致性流程(Medication Reconciliation Process)有效預防的,因此美國醫療機構評鑑聯合會於2004年宣布將藥物一致性流程納入國際病人安全準則,提供醫療機構於住院時應收集及記錄病人完整的用藥史,與現有住院處方對照以減少藥物疏失,並將更新確認之用藥明細交付給下一個照護機構。
研究目的:探討病人發生住院前後處方差異(本研究中定義為藥物疏失)的發生率、嚴重度及相關因素,並與住院期間發生藥物不良事件之關連性。
研究方法:以新住院病人為研究對象,收集病人資料及住院前用藥史,再以比對醫師開立之藥品處方,若有差異應與處方開立醫師確認,若非預期中發生之差異即為藥物疏失,分析疏失嚴重度及相關藥物。進一步使用ADE Trigger Tool追蹤樣本住院期間藥物不良事件的發生率及相關藥物反應。
研究結果:研究期間共計八周,有效訪視對象共150人,其中68人(45.5%)被記錄發生藥物疏失,在149筆疏失記錄中,以品項遺漏114筆(76.5%)最多,其次為劑量不同(8.1%)及劑型不同(7.4%);藥物類別以降血糖藥18次最多(12.1%)。病人的性別、過敏記錄、住院藥品處方筆數、住院前常規用藥筆數、與前次就醫不同科別住院與藥物疏失有顯著相關性(p<0.05)。住院期間發生藥物不良事件者共35人(23.3%),總發生次數48次;藥物類別以抗腫瘤用藥7次最多(14.6%)。但藥物疏失與藥物不良事件發生的影響並不顯著。
研究結論:藥物疏失常發生於住院或轉換照護機構的階段,找出與疏失發生的相關因素,並積極尋求照護服務及系統流程的改善,才能對病人治療產生正面的結果。
Background
According to the Joint Commission’s sentinel event database, medication errors result in death or major injury. Of those, 63% related to breakdowns in communication, and of those involving communication failures, approximately half would have been avoided through effective medication reconciliation: implement a process to document a patient’s current medication use, to use that information to optimize ordering and administration of new medications, and communicate an updated list to the next care provider at a transfer or discharge.
Objective
To determine the frequency, severity and factors associated with medication discrepancies(medication errors)and following up adverse drug events during admission to determine the frequency, severity and the relationship between medication errors and adverse drug events.
Method
We performed a prospective observational study. First, a standard preadmission medication history was taken by interviewer, and then compared with the admission medication orders. Medication discrepancies were communicated with physicians. If they were not clearly intentional were then recorded. Second, following up numbers of adverse drug events during admission to determine the frequency and severity by Trigger Tool method.
Result
We visited 150 patients in 8 weeks. Discrepancies were present in 68 patients(45.5%).The 149 medication errors were mainly distributed to the discrepancy type of omission(76.5%), different dose(8.1%)and different dosage form(7.4%).The most-related medications are anti-hyperglycemic agents(12.1%).Gender, allergy history, current medications, admission medication numbers, different specialized admission were significant correlates of discrepancy. Total 48 adverse drug events were happened in 35 patients(23.3%), and the most-related medications were oncology drugs(14.6%). Association between medication errors and adverse drug events are not significant.
Conclusions
Discrepancies were common among medication history and record. The prevalence of medication errors can have significant health care implications, and action is urgently needed to address their causes. Such actions have a positive impact on patient care.
論文電子檔著作權授權書 --------------------------- i
論文審定同意書 ------------------------------------ ii
誌謝 ----------------------------------------------- iii
中文摘要 ------------------------------------------- iv
英文摘要 ------------------------------------------- v
目 錄 ------------------------------------------- vii
表 目 錄 ------------------------------------------ ix
圖 目 錄 ------------------------------------------- xi
附錄目錄 ------------------------------------------- xii
第一章 緒論 --------------------------------------- 1
第一節 研究背景 1
第二節 研究目的與重要性 4
第二章 文獻探討 ----------------------------------- 6
第一節 病人安全策略 6
第二節 醫療疏失與不良事件 9
第三節 藥物疏失 12
第四節 藥物不良事件偵測 17
第五節 藥物不良反應 21
第七節 藥物一致性流程 24
第八節 藥物一致性流程實證研究 28
第三章 研究方法 ------------------------------------ 31
第一節 研究設計與流程 31
第二節 研究架構 33
第三節 研究假設 34
第四節 研究對象與資料收集 35
第五節 研究變項與操作型定義 36
第六節 統計方法 42
第四章 研究結果 ------------------------------------ 43
第一節 描述性統計 43
第二節 樣本變異數分析 57
第三節 相關性分析 72
第四節 多變項迴歸分析 75
第五章 討論 ---------------------------------------- 77
第一節 驗證假設 78
第二節 藥物疏失的研究與討論 80
第三節 藥物交互作用的研究與討論 83
第四節 藥物不良事件的研究與討論 85
第六章 結論與建議----------------------------------- 88
第一節 研究結論 88
第二節 醫療品質的建議 89
第三節 研究限制 92
第四節 未來研究方向 93
參考文獻 ------------------------------------------- 94
附錄 ------------------------------------------------ 103
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