門診處方箋內容格式探討

An Analysis on the Formats and Contents of Ambulatory Prescriptions

處方箋為醫師與藥師及病人間相互溝通之媒介，合法且完整的處方箋是藥事人員專業服務品質的要件。本研究藉由訪查法（含郵寄問卷及質性訪談），探討現行交付調劑門診處方箋內容格式，及藥事人員對於處方箋各欄位內容的看法。本研究以臺北縣社區藥局負責人及診所執業藥事人員為抽樣對象，然而縣政府衛生局授證之社區藥局用藥照護諮詢站則全數納入。本研究共回收505 份問卷（回收率52.6％），含社區藥局231 家、診所274 家；另自基層執業者及院所處，收集北區33 家醫療院所處方箋，包括中央健康保險局臺北分局轄區內醫學中心9 家（收集齊全度100％）、區域醫院10 家（55.6％）；面訪社區藥局及診所各9 名、8 名藥事執業者。問卷結果顯示，達八成以上藥事人員在處方確認步驟會檢閱的項目包括：病人姓名、醫療院所名稱、病人年齡或生日、處方日期，及藥品處方內容之各項訊息（除藥品學名及健保藥品碼外）；而在處方評估步驟時，藥品處方內容各訊息項目如過敏史、懷孕或授乳期、病人年齡、用藥史、診斷、服藥順從性、肝腎功能檢驗值等，其重要性（採10 分級距）認知之平均值皆在8 分以上。然而，對照所收集處方箋內容格式，發現目前各醫療院所之交付處方箋多缺乏過敏紀錄、體重、檢驗值等，至於學名、給藥途徑等訊息也不常見，可能造成處方覆核或藥品調配之不完整或低效率。在問卷或訪談中有極大比重流露對全國處方箋格式齊一化之期待（社區藥局8.6 ± 1.8、診所7.7± 2.2），此看法對調劑作業及用藥安全或能有所增進。本研究進一步整理比較國內外處方箋格式相關文獻，希冀能供相關機構參考設計，讓安全用藥體系更完善，藥事專業更充分發揮。

The prescription could serve as a means of communication among the prescriber, the pharmacist, and the patient. Legitimate prescriptions filled with required elements are essential for pharmacists to provide quality pharmaceutical care. This survey (both quantitative and qualitative research) study aimed to investigate the formats and contents of current outpatient prescriptions and pharmacists’ opinions on the importance of each individual item listed on a prescription. Pharmacists practicing at community pharmacies and clinics in Taipei County were both randomly selected, except that the pharmacists-in-charge of the authority-endorsed Community Pharmaceutical Care Center were all enrolled. A total of 505 questionnaires (response rate 52.6%), including 231 pharmacy and 274 clinic practitioners, were collected. A variety of prescription formats originated from 33 hospitals and clinics, encompassing nine medical centers (100% within the BNHI Northern Region) and ten district hospitals (55.6%), were acquired from local practitioners or respective institutions. Face-to-face interviews were performed with nine pharmacy and eight clinic practitioners. Our results revealed that more than 80% of pharmacists would check patient’s name, prescriber/institution’s name, patient’s age/birthday, date of issue, and every drug prescription details (except for generic name and NHI drug code) during the initial order verification process. The importance ratings for items such as allergy, pregnancy/lactating, age, medication profiles, diagnoses, adherence, and laboratory data were all above eight (on a scale of ten) by responders. Upon comparing the prescription-content statistics of released ambulatory prescriptions, information on allergy, weight, laboratory data as well as generic name and route of administration were often missing. This incompleteness of ambulatory prescriptions may lead to inaccurate or inefficient order verification and dispensing. A significant portion of practitioners have indicated, on questionnaires or through interviews, their preference (community pharmacies 8.6 ± 1.8, clinics 7.7 ± 2.2) for a consensus guideline on prescription formats and contents. In hopes of helping constructing better medication delivery system and pharmaceutical care in the future, a comparative analysis of local and international regulations on prescriptions is provided for health authorities, professional societies, and healthcare professionals.