目的： 為增進病人用藥安全，建立住院腎功能不全病人藥物合理劑量警示系統並定期檢討改善。

方法： 自2012 年起，將由藥師人工評估腎功能不全藥物劑量改為電腦審核，執行前後一個月結果，系統稽核劑量不合理件數比藥師評估不合理的件數多出了930 件，醫師接受率亦從32% 上升至43%，透過每月定期的開會討論，分析接受率偏低原因包括：腎功能資料庫中劑量和頻率建置不完全、藥物使用於不同途徑之劑量與頻率不同、臨床特殊族群用量不同。並針對原因進行改善方案，如：新增合理的劑量頻率、修改稽核邏輯以改善接受率。

結果： 此警示系統從2012 年5月到11月總建議件數共5,542 件，經過半年每月的分析與檢討改善，改善後不接受案件皆不再出現，且總接受率也由43% 上升至54%，p < 0.05。

結論： 此警示系統可提供臨床醫師即時性及資訊化的劑量建議，持續的檢討改善能加強此系統的實用性。未來將此系統移植至門急診及化療的醫囑中，以完整地為病人用藥安全把關。

Objective: To improve and monitor the dosage appropriateness for prescriptions among inpatients with renal function impairment, we established a computerized provider order entry-based alerting system advising appropriate renal dose adjustment in our institution.

Methods: A computerized provider order entry-based alerting system for appropriate renal dose adjustment was implemented in 2012 to replace the manual surveillance by pharmacists. For one month after inauguration of the computerized system, it alerted 930 more inappropriate prescriptions than manual surveillance by pharmacists. The acceptance rate for dose adjustment recommendations also increased from 32% to 43%. In addition, the reasons not accepting the dose adjustment recommendation were analyzed to improve the quality and performance of the system.
Result: The total suggestions of the alerting system were 5,542 from May to November 2012. The total rates of accepted intervention increased from 43 % to 54 % after performing quality improvement strategies.

Conclusions: The alert system provides clinicians a real-time renal dose adjustment suggestion. The framework could be implemented into outpatient order entry system to improve medication safety.