目的：為提升給藥即時性及藥物管理效能，於全院導入自動調配藥櫃 (automated dispensing cabinet, ADC) 及自動倉儲暨調劑系統 (carousel) 以改善住院藥物給藥流程並評估成效。
方法：一、自 2019 年 2 月至 2020 年 7 月，運用醫療團隊資源管理方式，以特性要因圖及決策矩陣分析手法擬訂對策：（一）導入 ADC；（二）優化 STAT（立即使用）藥囑傳送機制；（三）導入自動倉儲暨調劑系統 (carousel)。二、分析藥師調劑作業時間、退藥量、STAT 藥囑傳送次數、傳送時間、給藥時間、護理師額外急領藥次數及藥物錯誤率，並進行護理師及藥師滿意度調查。
結果：導入 ADC 和 carousel 半年後，藥師減少 5.3 小時／日調劑作業 (p = 0.003) 與 29.5% 退藥量 (p = 0.037)。STAT 藥囑傳送從 29.6 ± 2.4 減少至 11.8 ± 4.1 次／日(p = 0.004)，傳送時間從 72.2 ± 25.6 縮短為 8.4 ± 8.3 分鐘 (p < 0.001)，給藥時間從133.5 ± 118.2 縮短為 22.7 ± 18.3 分鐘 (p < 0.001)；護理師額外急領藥次數從 44.3 ± 6.5減少至 13.7 ± 1.8 次／日 (p = 0.004)，全院藥物調劑錯誤率減少 78.8%，給藥錯誤率減少 80.4%。護理師、藥師滿意度（5 分量表）於導入中、後期分別為 3.7 ± 0.6、3.8 ±0.7，以及 4.0 ± 0.7、4.2 ± 0.7。
結論：全院導入 ADC、carousel 及 STAT 藥囑傳送流程優化後，顯著減少病人立即用藥給藥時間、傳送人員傳送藥品次數、藥師調劑時間與退藥量、護理師候藥時間與急領藥次數，同時降低藥物錯誤。藥師和護理師能有更多時間運用在臨床照護，提升病人用藥安全。

Objective: This study aims to evaluate the implementation of automated dispensing cabinets (ADCs) and carousels to improve the process of inpatient drug delivery.
Methods: From February 2019 to July 2020, utilization of a fishbone diagram and decision matrix analysis led to the implementation of ADCs and carousels as well as the optimization of the STAT order delivery process, followed by analyses of dispensing time, drug return, STAT order delivery cases, delivery and administration times, extra urgent-delivery cases, medication error rates, and the satisfaction of nurses and pharmacists.
Results: Within 6 months after the implementation of the ADCs and carousels, pharmacist dispensing time and drug return respectively reduced by 5.3 hours/day (p = 0.003) and 29.5% (p = 0.037). In addition, STAT order delivery cases dropped from 29.6 ± 2.4 to 11.8 ± 4.1 times/day (p = 0.004), delivery time decreased from 72.2 ±25.6 to 8.4 ± 8.3 minutes (p < 0.001), and administration time fell from 133.5 ± 118.2 to 22.7 ± 18.3 minutes (p < 0.001). Extra urgent-delivery cases decreased from 44.3 ± 6.5 to 13.7 ± 1.8 times/day (p = 0.004), and error rates of medication dispensing and administration respectively reduced by 78.8% and 80.4%. Finally, the 5-point satisfaction of nurses and pharmacists respectively improved from 3.7 ± 0.6 to 3.8 ± 0.7 and from 4.0 ± 0.7 to 4.2 ± 0.7 points.
Conclusions: The implementation of the ADCs and carousels and an optimized STAT order delivery process significantly not only decreased delivery cases, delivery and administration times, dispensing time, drug return, and extra-urgent delivery cases, but also reduced medication error; thus, pharmacists and nurses have more time to focus on more critical aspects of their roles, such as clinical care and medication safety.

Summited for publication: 2021.2.5; Accepted for publication: 2021.6.5