以電腦系統監測腎功能不全患者經腎臟排泄之用藥

Monitoring of Renal Excretion Drugs in Patients with Renal Insufficiency through a Computer System

10.6320/FJM.2006.10(3).03

戴慶玲(Ching-Ling Tai)；陳一伶(I-Ling Chen)；王郁青(Lily Yu-Chin Wang)；李浩銓(Haw-Chyuan Lee)；李炳鈺(Ping-Yu Lee)

腎功能不全 ； 藥物不良反應 ； 用藥安全 ； Renal insufficiency ； adverse drug reaction ； medication safety

台灣醫學

10卷3期（2006 / 05 / 01）

302 - 308

繁體中文

腎功能不全患者常因藥物累積而導致藥物不良反應。經電腦設定29項『高比例經腎排除藥物』，自動篩選血清肌酐酸值大於1.5mg/dL之處方，由藥師利用其彙整資料進行藥事服務並提出用藥建議。六個月的監測中共有4,912筆資料，刪除重複處方後共有2,835筆，其中364筆(12.8%)具有爭議性，需由藥師介入來調整用藥內容；醫師對藥師介入後的處方修改比例為87.9%；其中在24小時內更改處方的比例為58.1%；而在建議調整藥物的內容方面，64%處方需降低給藥劑量或延長給藥間距，22.3%則建議停藥以免發生藥物不良反應。經由此監測系統的建立，可以有效且快速監測腎功能不全患者的用藥，避免藥物累積導致腎功能惡化或藥物不良反應的發生，讓這些特殊族群的用藥更加安全有保障。

Renal insufficiency has been associated with an increased risk of adverse effects due to drug accumulation. A computer-based system was designed to enable pharmacists to quickly review medication orders for patients with serum creatinine over 1.5 mg/dL and receiving 29 renally eliminated drugs. After evaluation of patients' conditions, pharmacists provide recommendations to the physicians. During a period of 6 months, 4912 prescriptions were screened. After deleting the duplicated prescriptions, pharmacists contacted physicians concerning 364 out of the 2,835 prescriptions for modification. Among the pharmacists' recommendations, 233 prescriptions were suggested to be modified as the reduction in the maintenance dose and/or increase in the dose interval, and 81 were suggested to be discontinued to avoid adverse drug reactions. However, only 320(87.9%) pharmacy interventions were accepted by physicians. Moreover, 58.1% of these accepted cases were modified by physicians in 24 hours after pharmacists suggested. Through the establishment of the computer-based screening system in monitoring of high fractional renal excretion drugs, pharmacists can quickly and effectively evaluate cases and adjust dosage of medication in patients with significant renal impairment. Consequently, deterioration of renal functions or adverse drug reactions resulted from accumulation of drugs can be avoided. Therefore, quality of medical care for the renal impaired patients is improved.