某長期照護機構住民藥物治療問題之評估與處置

Evaluation and Treatment of Medication-related Problems in a Long Term Care Facility

10.6317/LTC.201012_14(3).0004

黃畹藀(Li-Hua Huang)；葉淑芬(Shu-Fan Yeh)；陳昭元(Edward Chen)；林妍如(Blossom Yen-Ju Lin)

長期照護機構 ； 社區藥師 ； 老人用藥評估 ； 藥物治療評估 ； 藥物治療問題 ； long term care facilities ； community pharmacist ； elder medication evaluation ； drug regimen review ； medication-related problems

長期照護雜誌

14卷3期（2010 / 12 / 01）

277 - 291

繁體中文

本研究旨在探討社區藥師介入一長期照護機構的老人住民用藥評估，並針對所發現的用藥問題來提出具體適當的用藥處置，期望解決長期照護機構住民之藥物治療問題。本研究為期18個月，共計收案50位住民。社區藥師首先將所有住民之基本資料及藥歷檔以電腦建檔，並且每個月至少到機構進行二次例行性用藥評估，再者，當特殊狀況，如新住民或處方有變更，以及住民有非常規性的門診、急診、住院、跌倒、疑似藥物副作用、病況惡化、混亂或行為異常時，藥師也需要不定期地用藥評估與記錄。 研究結果發現，在為期18個月的藥師介入計畫中，總共發現154件藥物治療問題，而有七成住民至少曾經發生一次藥物治療問題事件。住民所發生的藥物治療問題包括藥物不良反應(44%)、不必要的藥物治療(25%)、藥物交互作用(13%)、及藥物劑量過低(10%)等。約七成三的藥物治療問題係由藥師發現與提出，而約有二成七的藥物治療問題係由護理人員協助通報。 本研究結果指出，藥師介入長期照護機構能夠發現並解決老人住民之藥物治療問題，亦可與醫護人員進行專業團隊的合作，一起為提昇老人的用藥安全及照護品質而努力。

This study aimed to evaluate the elder residents' medications in one long-term care facility after the intervention by community pharmacists. It was expected to identify the medication problems and propose the appropriate medication comments to enhance drug therapies. The study period was 18 months with 50 elder residents included as our study subjects. The trained pharmacists regularly visited the residents twice a month to evaluate the medications of the elderly. In addition, pharmacists were requested to evaluate the elder residents in time when he/she has one of the following situations, including the new admission of the residents, prescriptions changing, irregularly outpatient visits, emergency cases, inpatient stays, falls, side-effects, worsen conditions, and behavior disorder or confusions. The elder residents' personal characteristics, medical history and medication records were used to identify the medication-related problems and relevant treatments were proposed. It was found that seventy percent of the elder residents have medication-related problems, resulting in 154 cases occurring medication-related problems. The medication-related problems included adverse drug events (44%), unnecessary drug therapy (25%), drug-drug interaction (13%) and under doses (10%). These medication-related problems were first identified by nurses (27%) and pharmacists (73%). In Taiwan, the roles and functions of pharmacist were used to be ignored in the long term care settings. This study revealed that the introducing pharmacist practice into the long term care facilities could identify and resolve the medication-related problems. We argued the establishment of multidisciplinary teams that should include pharmacist to secure the medication safety of the elderly and thus their quality of care.