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研究生:于維寧
研究生(外文):Wei-Ning Yu
論文名稱:醫院導入條碼化作業之藥師滿意度及用藥安全成效評估-以某中部醫學中心為例
論文名稱(外文):Evaluation of the effectiveness of the satisfaction questionnaire on pharmacist and the medication safety after implementing the barcode system – An analysis of a medical center in central Taiwan
指導教授:黃光華黃光華引用關係
學位類別:碩士
校院名稱:中國醫藥大學
系所名稱:醫務管理學系碩士班
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:2015
畢業學年度:103
語文別:中文
論文頁數:59
中文關鍵詞:條碼給藥作業滿意度用藥安全
外文關鍵詞:barcode medication administration systemjob satisfactionmedication safety
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目的:醫策會報告指出台灣醫院發生藥物事件共18,622件。某醫學中心門診給藥作業現況常因藥師紙本審核、藥品識別錯誤、投錯藥袋、忙中有錯、不熟悉藥品或工作被打斷等因素,而導致調劑疏失,造成病人給藥錯誤。基於用藥風險管理,醫療院所導入條碼給藥系統,是當前成本較低且最有效的方式,本研究探討該醫學中心門診藥局導入條碼化給藥系統前後,對於藥師滿意度及用藥安全的成效差異。
方法: 本研究以使用者問卷調查做為評估系統建置成效的基礎,呈現某醫學中心運用條碼及資訊科技系統,建置門診藥局條碼給藥系統及其成效的評估。同時以該院病人安全通報系統之資料,呈現門診藥局導入條碼化給藥系統前後半年,對於用藥安全的改善成效。
結果:藥師使用滿意度調查,系統操作介面、硬體設備、使用者便利性、資訊正確性及工作績效考核相關性分析方面之間皆呈現顯著之正相關(p<0.01),表示具有中度相關(R值>0.6)。門診藥局條碼系統於2014年7月導入後,實施前後半年藥師調劑錯誤率由每月平均0.0025%下降至每月平均0.0018%;全院藥品類錯誤率由每月平均0.0129%下降至每月平均0.0052%。
結論: 條碼給藥系統會自動呈現警語或圖示,提醒藥師進行再次確認,但藥師有可能對於相關警示產生依賴性或對警示疲乏,值得管理者注意。全面使用條碼給藥系統調劑處方,完整監控調劑過程,避免調劑錯誤發生,提升病人用藥安全。

Objective: According to the Medical policy report, there were a total of 18,622 drug events had been reported in 2013. The reasons for medicine dispensing errors and distributing errors in a medical center outpatient pharmacy included: incorrect paper formed prescription reading, wrong medicine, wrong medicine pack, been interrupting, work overload and not familiar with the medicine. For the management of medication safety, hospital implemented a barcode system which is an effectiveness and economic efficiency way to meet the point. This study is to evaluate the outcome of medication safety and the pharmacists satisfaction after implementing the barcode system at the outpatient pharmacy.
Methods: The questionnaire was used as a baseline of evaluate tools to demonstratethe outcome of barcode system at outpatient pharmacy. Moreover, we used the data of reporting system to counter and to evaluate the improve result after implanting this barcode system.
Results: The Satisfaction Questionnaire on pharmacist used, operation interface, equipment, convenience of users, the information and performance evaluation were all indicated positive correlation (P value>0.01) , represents a moderate correlation (R value> 0.6). The dispensing error rate is decreased from 0.0025% per month to 0.0018% per month after implanting the barcode system. The global medication error rate is decrease from 0.0129% per month to 0.0052% per month.
Conclusion: The barcode system will pop up the warning or alarm to render pharmacists to make a double confirm. However, there are too many alarms and warning which can be irritating and annoying for pharmacists.
Implanting the barcode system in the pharmacy can help pharmacists to monitor the dispensing process and to avoid the dispensing error which leads good quality of patient safety.

目錄
摘要 i
Abstract iii
致謝 v
第一章 緒論 1
第一節、 研究背景與動機 1
第二節、 研究目的 3
第二章 文獻探討 4
第一節、 資訊系統成功模型 4
第二節、 用藥安全 6
第三節、 乳酪理論 11
第四節、 條碼技術 13
第五節、 條碼給藥系統 17
第三章 研究設計與方法 20
第一節、 研究流程 20
第二節、 系統設計與設計理念 23
第三節、 研究方法 31
第四節、 研究架構 32
第五節、 資料分析方法 33
第六節、 問卷之信效度分析 34
第四章 結果 38
第一節、 描述性統計 38
第二節、 推論性統計 41
第三節、 用藥安全效益 44
第五章 討論 45
第一節、 藥師滿意度調查 45
第二節、 用藥安全 47
第六章 結論 48
第一節、 結論與建議 48
第二節、 研究限制 49
參考文獻 50
附錄一:研究問卷 56
附錄二:縮寫對照表 59

表目錄
表2-1 用藥疏失常見的相關詞彙操作型定義 7
表2-2 QR Code特性說明 14
表3-1 各量表之內部一致性 (Cronbach’s α 值) 35
表4-1 受訪者之個人背景分析 38
表4-2 各構面平均分數及標準差 39
表4-3 滿意度3.5分以上 39
表4-4 滿意度3分以下 40
表4-5 皮爾森積差相關係數 41
表4-6 五大構面之相關性統計分析 42
表4-7 受訪者回饋意見 43


圖目錄
圖2-1 資訊系統成功模式 4
圖2-2 醫院藥物事件錯誤項目明細與錯誤階段交叉分析 10
圖2-3 乳酪理論 11
圖2-4 條碼給藥系統技術應用於藥物使用過程的關鍵步驟 19
圖3-1 研究流程 22
圖3-2 門診藥局條碼系統導入過程 23
圖3-3 門診藥局條碼系統流程 24
圖3-4 門診藥局作業系統條碼化前、後比較圖 25
圖3-5 門診藥局條碼系統作業流程圖 25
圖3-6 電腦輔助開方系統圖示 27
圖3-7 門診藥局條碼系統調劑畫面 28
圖3-8 門診藥局條碼系統藥品資訊畫面 28
圖3-9 門診藥局條碼系統結合雲端藥歷-審核資訊畫面 29
圖3-10門診藥局條碼系統發藥雙重比對畫面 29
圖3-11門診藥局條碼系統分析報表圖 30
圖3-12門診藥袋QR Code功能 30
圖3-13研究架構圖 32
圖4-1 藥師藥品品項調劑疏失率 44
圖4-2 全院藥品類疏失率 44

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