目的：以2012 版比爾斯準則 (Beers criteria) 作為老年病人潛在不適當用藥(potentially inappropriate medication, PIM) 之參考，於醫囑端與藥局端分別建置藥品決策與PIM 藥品監測系統，以降低老年住院病人之潛在不適當用藥，進而提升病人用藥安全，降低醫療費用。
方法：某醫學中心以2012 版比爾斯準則建置醫囑藥品決策與PIM藥品監測系統，並比較此二系統介入前（2010 年1 月1 日至2011 年12 月31 日）、後（2013 年1月1 日至4 月30 日）對降低65 歲（含）以上住院老年病人潛在不適當用藥之成效。
結果： 藥品決策及監測系統介入後，65 歲（ 含） 以上住院病人之老年PIM 醫囑下降 (64.04% vs. 51.95%, p < 0.001)。主要不適當用藥品項， 針劑為metoclopramide； 錠劑為lorazepam、amiodarone、doxazosin 及spironolactone。醫囑藥品決策系統於醫囑開藥時出現建議提示，共有71.43% 接受藥品修改建議；另藥師由PIM 藥品監測系統發現處方仍有PIM 者，由藥師進行用藥建議，接受修改者共92.45%。
結論：藥品決策系統及藥師介入對降低老人住院PIM 有其重要性，但在病人用藥習慣、健保藥品設限，以及臨床替代藥品有限的情況下，潛在不適當用藥之使用率下降有限。而以比爾斯準則開發之住院醫囑藥品決策系統於門診之應用是否更具效益，則有待後續之研究證實。

Objective: Using the Beers criteria 2012 as a basis for the use of potentially inappropriate medication (PIM) in the elderly and to establish a prescribing decision making and drug monitoring system and to reduce potential inappropriate medication in hospitalized elderly patients, enhance patient safety, and reduce medical costs.
Methods: Establish prescribing decision making and PIM drug monitoring system with Beers criteria 2012 in a medical center, and compare the efficiency of intervention these two systems before (Jan 1, 2010 to Dec 31, 2011) and after (Jan 1to Apr 30, 2013) to reduce the PIM in hospitalized patients aged 65 years and above.
Results: After the implementation of the prescribing decision making and PIM drug monitoring system PIM prescriptions were decreased (64.04% vs. 51.95%, p < 0.001). Major PIM prescriptions were metoclopramide injection, lorazepam tablets, amiodarone tablets, doxazosin tablets, spironolactone tablets. The physician acceptance rates were 71.43% from prescribing decision making system and 92.45% from pharmacist PIM detection, respectively.
Conclusions: Prescribing decision making system implementation and the interventions by pharmacists could help reducing PIM used in hospitalized elderly patients. However, due to physicians’ habits of medication use, restrictions on drug coverage by the National Health Insurance program, and the limitation of available alternative medications, it is difficult to significant reduce PIM use. Moreover, the efficiency of implementation of prescribing decision making system with Beer’s criteria in reducing outpatient prescription errors still requires further studies.