某精神專科醫院慢性病房院外藥品備藥改善專案

A Project to Improve Preparing Prescriptions Medications of Other Hospitals for Chronic Wards in a Psychiatric Hospital

10.6847/TJPMHN.201712_12(2).0003

黃湘淳(Shiang-Chuen Huang)；彭定華(Ting-Hua Peng)；梅心怡(Shin-Yi Mei)；林美伶(Mei-Ling Lin)；林幼喻(Yao-Yu Lin)；李依玲(I-Ling Li)；廖丸惠(Wan-Huei Liaw)；廖雅慧(Ya-Huei Liao)

院外藥品 ； 用藥安全 ； 備藥流程 ； medication prescriptions from other hospitals ； medication safety ； medication preparation procedure

精神衛生護理雜誌

12卷2期（2017 / 12 / 01）

24 - 34

繁體中文

背景：精神專科醫院受限無內外科資源，病人院外就醫之藥品，臨床由護理師採夾鏈袋將各種包裝製成餐包後給藥。因夾鏈袋易破損，標籤內容不一致，備藥過程須兼顧病房業務與突發狀況，院外藥物備藥耗時且易有錯誤，故收集院外藥品備藥時間平均為151.5秒／日／份，備藥錯誤率0.99%。目的：降低院外藥備藥時間至40秒／日／份；錯誤率至0%。方法：1.備藥裝置改採四格藥管，2.統一標籤內容，3.修改院外藥品備藥流程，4.調整備藥班別與天數，5.教育訓練、病房會議宣導。結果：評值院外藥備藥時間為26秒／日／份，降低82.8%，錯誤率降為0%，備藥時間及錯誤率皆有改善並達目標值。結論：運用創新概念，更改備藥裝置，建立標準化過程，除縮短備藥時間，更重要是調整備藥班別，減少環境干擾，降低備藥錯誤率，提升照護品質，落實病人用藥安全。

Background: There are limited resources of generic medicine in psychiatric hospitals; therefore, psychiatric in-patients who suffer from comorbid diseases need to take prescription from general hospitals to obtain aforementioned medicine. Nurses put these packets of medication in to zipper bags, and help patients to take the prescription in addition to the regular psychotropics. The defects of this procedure included possible damaged zipper bags, due to various labels of the medications and the limited time of nursing staff. The error rate and the average time for nurses to prepare medications that general hospitals prescribe were 0.99% and 151.5 second/day/portion, respectively. Objective: The project aimed to reduce the error rate from 0.99% to 0% and the preparing time from 151.5 second to 40 seconds/day/ portion. Methods: 1. Change the preparation devices to 4-cell pill organizers. 2. Unify label contents. 3. Revise procedures of medication preparation prescribing from other hospitals. 4. Adjust the schedule of medication preparation in the ward. 5. Promote new strategy through educating the staff. Results: The error rate was reduced to 0%. The time to prepare medications prescribing from general hospitals was decreased to 26 seconds/day/portion reducing by 82.8%. Conclusion: The project has utilized new methods, adjusted devices, and established a standardized medication administration procedure. The project not only reduced error rate and time to prepare medications, but also improved quality of care, as well as implemented medication safety to patients.

1. Cottney, A.,Innes, J.(2015).Medication-administration errors in an urban mental health hospital: A direct observation study.International Journal of Mental Health Nursing,24,65-74.
2. Haw, C.,Stubbs, J.,Dickens, G.L.(2014).Barriers to the reporting of medication administration errors and near misses: An interview study of nurses at a psychiatric hospital.Journal of Psychiatric and Mental Health Nursing,21,797-805.
3. Higuchi, A.,Higami, Y.,Takahama, M.,Yamakawa, M.,Makimoto, K.(2015).Potential underreporting of medication errors in a psychiatric general hospital in Japan.International Journal of Nursing Practice,21(Suppl. 2),2-8.
4. Hughes, R. G.,Ortiz, E.(2005).Medication errors: Why they happen, and how they can be prevented.The American Journal of Nursing,105(3 Suppl),14-24.
5. Maidment, I. D.,Haw, C.,Stubbs, J.,Fox, C.,Katona, C.,Franklin, B. D.(2008).Medication errors in order people with mental health problems: A review.International Journal of Geriatric Psychiatry,23,564-573.
6. Reis, A. M.,Marques, T. C.,Opitz, S. P.,Silva, A. E.,Gimenes, F. R.,Teixeira, T. C.,Cassiani, S. H.(2010).Errors in medicine administration-profile of medicines: Knowing and preventing.Acta Paulista de Enfermagem,23(2),181-186.
7. 台灣病人安全資訊網(2015).台灣病人安全通報系統 2013年 TPR年報· 取自 http://patientsafety.iifun.com. tw/Content/Downloads/List01.aspx?SiteID=1&Mmm ID=621273303702500244
8. 李雅惠,許玉珍,洪英俊(2007)。安全的給藥作業。慈濟醫學，19(11)，41-44。
9. 林昌宏(2007)。病人安全事件提醒─分裝藥物未標示。財團法人醫院評鑑暨醫療品質策進會，21，1-2。
10. 林恆慶,陳楚杰,許銘恭(2003)。病人安全相關議題之探討。中華民國醫院協會雜誌，36(5)，69-78。
11. 林淑貞,簡守信(2007)。用藥安全是病人安全的首要目標。慈濟醫院，19(1)，1-4。
12. 施淑鳳(2011)。探討護理人員給藥經驗與安全措施。志為護理，10(4)，14-23。
13. 陳玉枝(2004)。從護理照護層面談病人安全。台灣醫學，8(4)，528-534。
14. 陳彩鳳(2009).專案管理與寫作─醫護管理適用.台北:華杏.
15. 蔡沁筠,張文英,陳淬瑄,黃秋景(2007)。提昇護理人員口服給藥正確性之改善專案。新臺北護理期刊，9(2)，61-70。
16. 戴定玲(2005)。護理人員用藥安全之臨床實務。榮總護理，22(2)，132-138。