目的：為提升重症病人首日量藥物之給藥即時性，本院導入智慧藥櫃 (automated dispensing cabinet, ADC) 進行即時用藥管理，並評估此作法之效益。
方法：於ADC 導入前後收集外科加護病房 (surgical intensive care unit, SICU)護理人員候藥時間以評估給藥即時性，分析首日量調劑次數改由ADC 配發之占率與配發錯誤事件，調查退藥作業中，藥囑改藥、退藥與取消臨時醫囑由ADC 配發占退藥之比例，及藥師補藥所需花費時間，並於ADC 導入前、中、後期進行護理人員滿意度調查。
結果：給藥即時性：相較傳統藥袋流程，ADC 即時用藥管理系統的建置，平均每筆處方等候時間由83.1 ± 39.6 縮短至4.0 ± 11.2 分鐘。首日藥量改由ADC 配發之占率：67.9% （14,407/21,206 筆）。期間ADC 品項沒有配送錯誤事件。退藥作業：SICU 藥囑改藥退藥品項2,153 筆及取消臨時醫囑221 筆中，由ADC 給藥而無須退藥歸藥處理者各為650 筆 (30.2%) 及182 筆 (82.4%)。護理人員滿意度：由導入前期32.4%、導入中期82.5%，到導入後期90.5%，有大幅的提升。
結論：應用ADC 於SICU 首日藥量配發，可改善給藥即時性與配送錯誤事件的發生。此經驗可持續水平展開至急診與其他病房，並以此ADC 使用之成功模式分享與其他醫療院所，提供更為安全的即時性藥物管理系統。
Objective: To evaluate the effectiveness of drug delivery using the automatic dispensing cabinet (ADC) in the surgical intensive care unit (SICU).
Methods: Before (i.e., the conventional system) and after implementation of ADC in the SICU, we recorded the following data: the waiting time of nursing staff, the number of the first day prescriptions, the number of delivery errors, the number of drug returns, and results of a satisfaction survey of ADC nursing staff.
Results: Immediacy of drug delivery: compared to the conventional drug delivery system, ADC real-time medication management system shortened the average waiting time of nursing staff from 83.1 ± 39.6 to 4.0 ± 11.2 minutes per prescription. The ADC dispensing rate was 67.9% (14,407/21,206). There is no delivery error event for the ADC item. Drug returns to the pharmacy: a total of 2,153 routine and 221 STAT prescriptions needed to be returned to pharmacy. Among them, 650 (30.2%) and 182 (82.4%) prescriptions were administered by ADC without returning the drug. The nursing staff’s satisfaction progressively elevated with time: 32.4% early stage, 82.5% mid-stage, and 90.5% late stage during the implementation of ADC.
Conclusions: The ADC real-time medication management system improved the immediacy of drug delivery to patients in the SICU with fewer drug delivery errors. In the future, we plan to extend this system to the emergency department and other wards. We expect that this successful model will soon be adopted by other hospitals.
