社團法人臺灣臨床藥學會

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【原著】電腦醫囑輸入系統建立抗生素劑量試算改善醫囑劑量疏失
Implementing antibiotic dosage calculator in a computerized physician order entry system: evaluate the influence on improper prescription dosing errors
電腦醫囑輸入系統、抗生素、 劑量疏失、劑量試算功能、 CPOE、antibiotics、dosing error、 dosage calculator
王慧瑜Hue-Yu Wang1 、陳麗芳Agnes L.F. Chan1 、黃孟煦Meng-Hsun Huang2
1財團法人奇美醫院藥劑部 、2財團法人奇美醫院病理部
在所有通報的用藥疏失事件中,醫 囑劑量錯誤是常見的形式之一。劑量錯 誤發生率高,主要原因是醫師在開立醫 囑時未能根據病人的體重、腎功能與仿 單提供的標準劑量建議為考量,忽略特 殊病況所導致的腎功能不穩定而需要不 斷調整劑量的結果,且發生劑量疏失的藥物中以抗生素最為常見。為了減少醫 囑劑量疏失的發生,我們發展在電腦醫 囑 輸 入 系 統 建 立 抗 生 素 劑 量 試 算(ntibiotic dosage  calculator implemented into CPOE,  CPOE-ADC),此劑量試算功 能可根據病人的最新資料,如年齡、體 重、腎功能等提供 16 種抗生素的劑量建 議,並評估於電腦醫囑輸入系統建立抗 生素劑量試算對於降低醫囑劑量疏失之成效與醫師對此功能之接受度。
自 93 年 4 月 1 日至  94 年 12 月 31 日,分析 CPOE-ADC 建立前後電腦醫囑 所開出抗生素劑量疏失筆數。研究期間 共分析了 36,691  筆抗生素醫囑,而抗生 素劑量疏失發生率從   CPOE-ADC 建立 前的  11.6%下降到 2.0%;此功能上線後 的初期、中期、後期,醫師對系統劑量 建議之接受度分別為  76.7%、81.6%及96.3%。醫師對於 CPOE-ADC 使用方便 性之滿意度為優者達 100%,對操作滿 意度為 81.1%,整體滿意度 94.6%。研究結果發現  CPOE-ADC 對於降 低醫囑抗生素劑量疏失確實有所助益, 而試算操作簡化並作實施前的宣導,能 提昇醫師的  CPOE-ADC 使用率與滿意 度。
 
Improper dosing errors is one of the most common type for all reporting medication errors, one of the major reasons for the high rate of dosing errors is that most medications are prescribed on the basis of patients’ weight, renal function and a standard dosing provided by instructions recommendation. Due to most of complicated patients’ particular conditions, patients’ renal function may be deteriorated with a progress diseases, antibiotic dosage regimens need to adjust continuously, and those can cause the incidence of dosing errors increased. Antibiotics are one of the most common agents among prescribing dosing errors. To minimize the prescription dosing errors, we developed an antibiotic dosage calculator in a computerized physician order entry (CPOE) system. There are 21 antibiotics and provide dosage and dosing interval recommendations according to patients’age, weight and renal functions. Our objective is to study the influence of implementing antibiotic dosage calculator in CPOE system to decrease prescription dosing errors. The rates of physician accept  recommendations by  CPOE-ADC  were also determined.
We analyzed the entire electronic antibiotic dosing errors order since April 1, 2004 to December  31,  2005.  During the study  period,36691 antibiotic physician orders prescribed before and after CPOE-ADC system developed were   analyzed.   In this study  the rates  of antibiotic prescription dosing errors were decreased from 11.6 to 2.0 % after the calculator was  developed. Physician accepts rates  of  the recommendations by the calculator at the initial, middle and late phase were 76.7%, 81.6% and 96.3%, respectively. The physician satisfaction of usage, operation  facility,  and  whole  satisfied were 100%, 81.1% and 94.6%.
We concluded that implementing antibiotic dosage calculator in a  CPOE system can help decrease the incidence of prescription antibiotic dosing errors in  this study. Simplify operation process and announce it to relevance staff will promote the usage rate and satisfaction before the calculator going to carrying out.
 
 
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