目的：醫學上有許多助記口訣的應用讓臨床工作得以標準化，但在藥事照護日漸多面向的今日，相關的助記口訣卻鮮少被創造。本文提供在加護病房 (intensive care unit, ICU) 及住院藥局工作的藥師一個容易記憶、標準化且能協助辨識藥品相關問題（drug-related problems，DRPs）的助記口訣，讓藥事服務得以順利開始。
方法：本研究於單一區域教學醫院中執行，回溯性分析區間為2021 年1 月1 日至12 月31 日，前瞻性研究區間則為2022 年1 月1 日至12 月31 日。PHARMACIST (Patient visiting, High alert medications, Antimicrobial stewardship, medication Reconciliation, Monitoring, dose Adjustments, Compatibilities, drug-drug Interactions, Start and Stop, medication appropriated for Tube feeding) 助記口訣被創造後，先對受試者進行介紹與教學，收集臨床情境試題的前、後測與問卷，進行教學成效評估；隨後將助記口訣實際應用至臨床上，收集受試者於12 個月內對於住院病人（含ICU 及其他病房）的判斷性服務案件數量及內容，對照前12 個月的回溯性資料，作為臨床應用成效評估。主要評估指標包含：臨床情境試題中發現DRPs 的數量、住院病人判斷性服務之案件數量及照護介入的分類、醫師接受藥師建議而調整處方的比率。
結果：30 位藥師在臨床情境試題的後測中，平均每人發現DRPs 的數量增加 (3.9 ± 3.2 vs. 9.0 ± 4.3)；將助記口訣應用至臨床上後，判斷性服務案件總量增加 (259 vs. 414)，其中約63% 來自於ICU 案件。藥師介入最多的前三項依次為：「用藥劑量／頻次問題」 (35.0%)、「建議用藥／建議增加用藥」 (14.7%)、「建議更適當用藥／配方組成」 (12.6%)。醫師接受藥師建議的比率亦有提高 (92.5% vs. 98.6%)。
結論：PHARMACIST 助記口訣為好的教學工具，由於具備標準化的特質，方便藥師逐一對照並辨識出病人用藥上的DRPs，使藥事服務上手容易。當應用至臨床上，不僅讓ICU 專責藥師維持服務的一致性及避免疏漏，也適合推廣至其他病房的藥事照護。一旦藥師辨識DRPs 之能力提升，更能增進病人用藥安全。
Objective: Although numerous medical mnemonics support clinical process standardization, mnemonics are rarely used in pharmaceutical care. This study aimed to introduce pharmacists to the mnemonic “PHARMACIST” (Patient visiting, High alert medications, Antimicrobial stewardship, medication Reconciliation, Monitoring, dose Adjustments, Compatibilities, drug-drug Interactions, Start and Stop, medication appropriated for Tube feeding) for easy process memorization and standardization and drug-related problem (DRP) identification and for facilitating the provision of pharmaceutical services.
Methods: This study was conducted at a regional teaching hospital and involved a retrospective analysis from January 1 to December 31, 2021, and a prospective study from January 1 to December 31, 2022. The PHARMACIST mnemonic was introduced to participants, and its effectiveness as a teaching tool was evaluated using pretests, posttests, and questionnaires featuring clinical scenario questions. Subsequently, the mnemonic was applied in clinical practice for collection of data on cognitive pharmaceutical services provided to inpatients (including those in the intensive care unit [ICU] and ordinary wards) over 12 months. These data were compared with those from the previous 12 months for assessment of the real-world clinical effectiveness of PHARMACIST. The primary outcomes assessed were the number of DRPs identified in clinical scenario questions, number of cognitive pharmaceutical services provided to inpatients, classification of pharmaceutical interventions, and physician acceptance rate.
Results: The average number of DRPs identified in the clinical scenario questions among 30 participants was greater in the posttest than in the pretest (3.9 ± 3.2 vs. 9.0 ± 4.3). Clinical implementation of the mnemonic resulted in an increase in the number of cognitive pharmaceutical services provided to inpatients (259 vs. 414), approximately 63% of which were provided in the ICU. The pharmacists’ interventions predominantly comprised treatment dosage/frequency adjustment (35.0%), pharmacotherapy/additional medication recommendation (14.7%), and suggestion of more appropriate medication/formulation (12.6%). There was also an improvement in physician acceptance rate (92.5% vs. 98.6%).
Conclusions: The PHARMACIST mnemonic enables a standardized approach to identifying DRPs and thereby facilitates the provision of pharmaceutical services. It can be used in clinical practice by ICU-dedicated pharmacists to provide consistent services and avoid omissions. It is also suitable for introduction to ordinary wards for pharmaceutical care. With PHARMACIST, medication safety can be significantly improved through greater DRP identification.
Submitted for publication: 2023.6.1; Accepted for publication: 2023.7.12
