提升肝臟移植門診病人服藥正確率

Improvement of Medication Accuracy for the Post-liver Transplantation Patients

本專案目的為提升肝臟移植門診病人服藥正確率，門診中發現病人出現服藥時間、使用劑量錯誤或血中藥物濃度檢查時間不正確等情形，造成醫師治療上的困擾，更影響病人用藥安全。經調查肝臟移植門診病人服藥正確率僅85.7％。分析原因為病人對肝臟移植藥物認知正確率低僅79％、病人未依醫師囑咐調整藥物劑量；護理人員對於病人用藥指導缺乏一致性且未追蹤評值；且門診欠缺藥物指導流程及工具。經實施肝臟移植門診藥物更改提醒單、肝臟移植門診常用藥物指導衛教本、肝臟移植門診藥物指導流程、安排團體衛教講座等改善措施後，病人服藥正確率提升至100%、肝臟移植藥物認知正確率提升至96.8%，顯示經由團隊的努力確實能提升肝臟移植門診病人服藥正確率及認知，有助於提升門診照護品質。

In the post-liver transplantation outpatient clinic, several issues like the optimal medication timing, prescription dosage, and blood sampling timing were critically related to the clinical adverse events. Hence, a protocol has been advocated to improve the medication accuracy for this particular population. Based on our study, the medication accuracy at this clinic was merely 85.7%. The causative analysis revealed that suboptimal patient’s recognition of the medications (79%), neglected dosage readjustment, absence of standard prescription instruction and follow-up, and absence of paradigms and instruments for prescription instruction were related to the unfavorable outcomes. Therefore, several measures were adopted, including delivery of prescription readjustment notification and standard prescription instruction, adoption of paradigms for prescription instruction, and organization of group educational seminar. Accuracy of medication and optimal patient’s recognition of the medications were increased to 100% and 96.8%, respectively. Based on our experience, we conclude that the medication accuracy and the patient’s recognition of the medications can be improved by the efforts of group practice.