慢性腎疾病影響腎臟藥物的排除，腎功能不全之患者應適時地調整劑量， 以免藥物蓄積而造成嚴重的不良反應。 針對 32 項主由腎臟排除或具腎毒性的 藥物，初期(2004.10~2004.12)由資訊系 統自動篩選出使用上述藥品且血清肌酸 酐 > 1.5 mg/dl 之患者，藥師檢視劑量的 正 確 性 並 提 出 建 議 ， 建 置 後 一 年 近 期 (2006.02~2006.04) 則 於 醫 師 開 立 處 方 前，加入腎功能不全提示視窗，以期增 加處方之正確性。
評估資訊自動篩選系統建置完成初 期(2004.10~2004.12)及建置完成後一年 近期(2006.02~2006.04) 之成效。資訊自動篩選系統篩選 出病人 總數初期 /近期各為 3543 / 3055 人次，藥師介入之筆數 各為 714 (20 %) / 235 (7.7 %)。具腎毒性 之 gentamicin 其處方的正確性由 49.8 % 提升至 83.8%，主由腎排除 metformin 及 digoxin 其處方的正確性分別由 47.4% 提升至 62.5%及 75.9%提升至 92.2%，全 體 32 品項其醫師開方適當性由 70.7%提 升至 92.3 %。
此資訊自動篩選系統建立後，全面 性的監測住診腎功能不全之成人病患， 使得腎功能不全者處方之正確性顯著提 高，提升腎功能不全之患者用藥安全， 也使藥事照顧的服務面更廣。
Inappropriate dosing in patients with renal insufficiency may cause serious adverse drug events. A computerized-assisted screening system was designed to monitor the dosing of renally excreted drugs in hospitalized patients with renal insufficiency.
We selected 32 drugs, which were removed principally by kidneys or hazardous to kidneys for examination. This computerized-assisted screening system was established and enforced in October 2004. The patients with creatinine >1.5 mg/dl and prescribed above-mentioned 32 drugs were screened out by this computerized-assisted screening system.
Pharmacists evaluate patients’ condition and provide the dosage recommendation to the physicians.
This research compared the efficacy in the primary stage (10/2004~12/2004) and the one-year-later stage (02/2006~ 04/2006). It shows that the patients screened out by this system were 3543 and 3055 person-cases in primary and one-year-later stages, respectively. The number of pharmacists’ recommendations were 714 (20%) and 235 (7.7%) in primary and one-year-later stages, pharmacy interventions accepted by physicians were61.5% and 72.3 % respectively.
The prescription correctness of the gentamicin, metformin and digoxin were increased from 49.8% to 83.8%, 47.4% to 62.5% and 75.9 % to 92.2%, respectively. The appropriateness of the total 32 drugs was increased from 70.7 % to 92.3 %.
The computerized-assisted screening system may be helpful for physicians and clinical pharmacist and may improve the patient safety.
