目的：

執行精準用藥推動方案，期望讓醫師精準處方、藥師精準調劑、護師精準給藥、病人正確用藥，達成精準用藥目標。

 

方法：

成立精準用藥推動小組，運用平衡計分卡 (balanced scorecard) 手法，經由市場、產業環境分析及內部資源調查，並運用SWOT 分析形成三個策略主題：

一、提升用藥安全，發展臨床決策輔助系統；

二、優化整合服務，強化智能調劑與給藥系統；

三、健全用藥指導模式。

並展開形成策略地圖，制定策略目標、績效關鍵指標、行動方案。

 

結果：

2019 年執行成效整體達標率95.2%；財務構面達成率88.3%：減少重複用藥核扣費30%。顧客構面達成率85%：降低不適當用藥50%；首創全時段精準用藥藥師門診，改善服藥順從性。內部流程構面達成率100%：完成臨床路徑系統導入、用藥連貫性比對系統、處方審核資訊化；智慧調劑台導入；建置照會藥師整合用藥機制及藥師門診衛教模式；提升精準用藥門診服務人次。學習成長構面達成率98.5%：舉辦精準用藥教育課程、智能調劑給藥系統使用滿意度 > 85%、完成衛教教材出版。

 

結論：

透過平衡計分卡，能有系統的擬定精準用藥推動方案與管理指標，並透過整合性團隊，方能依序完成相關行動方案與達成指標，確保病人用藥安全，並減少醫療資源浪費，提升醫病滿意度，達到病人與醫院雙贏之目標。

 

Objective: 

To achieve the goal of precision prescription by physicians, precision dispensing by pharmacists, precision administration by nurses, and precision medication use by patients, a promotion scheme for precision medication use was adopted in Changhua Christian Hospital.

 

Methods: 

The institution recruited the “Precision medication promotion task force”, and used the balanced scorecard to investigate the market, the industrial environment, and internal resources. Three strategic objectives were developed through SWOT analysis: 

1. Improving medication safety and developing a clinical decision support system; 

2. Optimizing the integration of pharmaceutical care services and enhancing the design of intelligent dispensing and administration systems; 

3. Intensifying the patient medication counseling model. 

Through the strategy map, the goals for strategies, key performance indicators (KPIs), and action plans were established.

 

Results: 

Total scheme achievement rate in 2019 was 95.2%. KPIs achievement rate was 88.3% in the financial perspective, with a 30% of reduction in the cost of therapeutic duplication. KPIs achievement rate was 85% in the customer-related perspective, with a 50% of reduction in inappropriate prescriptions. The first precision pharmacy clinic was established to improve medication adherence. KPIs achievement rate for internal process perspective was 100%, including the introduction of clinical pathways, electronic medication reconciliation system, prescription evaluation system, intelligent medication dispensing system. The counseling model for pharmacy clinics was established, and patient visits to precision pharmacy clinics have increased. KPIs achievement rate of the learning and growth perspective was 98.5%, including the provision of lectures for precision medication, over 85% satisfaction rate for intelligent dispensing system, and the publication of patient education materials.

 

Conclusions: 

A promotion scheme for precision medication use and management can be systematically developed through the BSC tool. With the integrated task force to execute action plans, we can ensure patient medication safety, reduce the waste of medical resources, promote healthcare satisfaction, and achieve a win-win situation between patients and hospitals.

 

 

Summited for publication: 2021.4.23; Accepted for publication: 2021.7.12