目的： 醫療人員對正確藥物投與的認知，攸關病人用藥適當性與安全性。本研究由藥師進行處方提示設計、教育宣導與處方審核，評估管灌病人不適當用藥的改善程度。
方法： 為評估某醫學中心管灌病人處方適當性，於2009 年4月至2010 年5月間，每週進行管灌病人處方審查，並比較提示機制介入前後六個月不宜磨粉處方或給藥方式不當之比例。藥師同時展開對醫護人員有關提示系統使用的注意事項與管灌用藥之知識。
結果： 不當劑型處方筆數占處方審核之總人次，由介入前的10.7 筆／ 100 審核人次（530 筆／4,934 審核人次）降低為提示機制介入後4.0 筆／ 100 審核人次（199 筆／4,947 審核人次）。結果顯示平均每週藥師審查100 管灌病人處方一次，不當劑型處方減少15 筆。研究期間對醫護人員進行25 場正確用藥觀念訓練課程，共計約800 人次參與。
結論： 醫院藥師參與管灌病人處方提示建置，能改善不當劑型處方與給藥方法。惟需持續加強醫護人員之認知與藥師之溝通訓練，讓管灌病人用藥適當性最佳化。
Objective: Health professionals with sufficient information and expertise are critical to ensure the appropriateness of medication administration and patient safety. The study is to assess the effect of pharmacist-initiated prescription alert system on improving the medication administration practice among patients underwent tube-feeding in a tertiary medical center.
Method: Inappropriate prescription was defined for those drugs’ dosage forms or formulations are not recommended to crush or mix. Integrated with electronic order entry system, alerting system was developed to inform physicians with reasoning and alternatives to avoid inappropriate uses.
Training, educational meetings and supports were taken to ensure health professionals being familiar with the alert system. Six months before and after the implementation of alerting system,the inappropriate prescription rates (numbers of prescriptions divided by total numbers of patients reviewed weekly in the period) were compared to demonstrate the effect of interventions.
Result: Based on the pharmacist’s weekly reviews (4/2009 ~ 5/2010), the inappropriate prescription rate declined from 10.7 prescriptions / 100 person-time (530 prescriptions / 4,934 person-time reviews)to 4.0 prescriptions / 100 person-time (199 prescriptions / 4,947 person-time reviews). The results indicated that on average, avoid 15 inappropriate prescriptions per 100 patients reviews after the implemention of prescription alerts system
Conclusion: A pharmacist-initiated electronic prescription alert system has the potential to decrease improper prescriptions for patients feeding with tube. The study is preliminary, but highlights the importance of a multidisciplinary approach involving nurses, physicians and pharmacists to appropriate medication administration and quality of care in patients with feeding tube.
