提昇神經內科病房對藥物磨粉禁忌認知與正確執行率之專案

A Project to Improve Knowledge of Medications Incompatible with Pulverization and Accuracy of Dosage in a Neurological Ward

10.30167/JOIT.200812.0009

張玉馨(Yu-Shin Chang)；郭修儀(Hsiu-Yi Kuo)；周繡玲(Hsiu-Ling Chou)

藥物磨粉禁忌 ； 正確執行率 ； 神經內科病房 ； incompatibility of pulverized medications ； accurate performance rate ； neurological ward

亞東學報

28_S期（2008 / 12 / 01）

75 - 78

繁體中文

藥品爲確保某些特殊作用，會於劑型上做「加工」以達到服用的療效。由於神經內科病人的特性，常需管灌食或無法吞服錠劑，故需將藥物磨粉後以利病人服用，但並非所有的劑型皆可磨粉，臨床護理人員具有執行及確保給藥安全之職責，對於藥物磨粉禁忌的認知及正確執行給藥方式是不容忽視的議題。經深入的探討病房護理人員對此知識的認知，現況分析發現：（一）對藥物磨粉禁忌認知一知半解且無具體完整的概念；（二）醫院在職教育中缺乏相關教育課程；（三）藥局亦未給予藥物磨粉禁忌之相關資訊。本專案經由在職教育宣導、制訂不可磨粉藥物及替代藥物一覽表與稽核等相關措施。評值結果爲護理人員對藥物磨粉禁忌認知分數由60分提昇至100分；不宜磨粉原因認知由20分提昇至100分；藥物磨粉禁忌之正確執行率由15%提昇至85%。故建議本專案的成果可運用於其他病房，建立一套標準的藥物磨粉禁忌及替代藥物手冊，提昇臨床給藥的正確知識及維護病人用藥安全，進而提昇護理照顧品質。

Medications are assured of having certain effects, and can at certain dosages ”work overtime” to produce special therapeutic effects. Neurological patients, who are enable to swallow medications, often require tube feeding, so it is necessary to pulverize the medications to administer it to the patients. However, not all medications can be pulverized, so for clinical nurses, who have the duty of providing accurate doses of medication, knowledge of medications incompatible with pulverization and how to accurately administer the doses is an issue that cannot be neglected. Through a thorough investigation of nursing staff's understanding of this issue, the following has been learned：(1) they have partial understanding or incomplete concept of the incompatibility of some medications with pulverization; (2) hospitals lack courses on this subject in their an job training curricula; (3) pharmacies still do not provide information about incompatibility of medicines with pulverization. This project gives training guides which create a chart of medicines which should not be pulverized and substitutes for them, and to examine related measures. The results of evaluation are that nursing staff's level of understanding of medications incompatible with pulverization will increase from 60% to 100%; level of understanding of the unsuitability of pulverization will increase from 20% to 100%; accuracy of medications incompatibility with pulverization will increase from 15% to 85%. It is suggested that the results of this project can be used in other wards, that a set of standards for medicines which are incompatible with pulverization and their substitutes can be included in a nursing care, in order to increase the accuracy of administration of medications and to assure the patients medication safety, and to improve the quality of nursing care.

1. Charatan, F.(2001).Time release analgesic causes fatal overdoses in United States.British Medical Journal,322(7295),1143.
2. Cornish, P.(2005).Avoid the crush: Hazards of medication administration in patients with dysphagia or a feeding tube.Canadian Medical Association Journal,172(7),871-872.
3. Keill, P.,Johnson, T.(1993).Shifting gears: Improving delivery of medications.Journal of Nursing Quality Assurance,7(2),24-33.
4. Miller, D.,Miller, H.(2000).To crush or not to crush?.Nursing,30(2),50-52.
5. Mitchell, J.(2002).Oral dosage forms that should not be crushed or chewed.Hospital Pharmacy,37(2),213-214.
6. Smetzer, J.(2001).Take 10 Giant steps to medication safety.Nursing,31(11),49-53.
7. 毛錦玉、邱淑芬、莊琴英、陳瓊香、湯靜怡、楊馥美(1996)。探討骨科護理在職教育對護理人員之影響。榮總護理，13(3)，332-340。
8. 周千瀅、陳立奇、周美惠、林明芳(2002)。台北榮民總醫院臨床藥學科電話藥物諮詢作業現況分析之回溯性研究。醫院藥學，19(2)，33-41。
9. 徐美玲(1997)。最新基本護理學：原理與技術。台北:匯華。
10. 張清濱(1996)。教學研究的趨勢。研習資訊，13(5)，1-9。
11. 陳長安(2001)。常用藥物治療手冊，全國藥品年鑑。台北:
12. 陳貞如、李秀現、邱淑貞、陳清惠(2003)。內科病房違反給藥磨粉禁忌現況之初步調查研究。護理雜誌，50(3)，71-76。
13. 葉明功(1996)。藥物新劑型的發展現況。國防醫學，23(3)，232-236。
14. 鄭淑妃、林明芳、周美惠(2000)。破壞藥物安定或療效的不合理處方。臨床醫學，45(3)，210-212。