提升肝臟移植術後病人用藥指導之完整性

Improving Medication Instruction for Post-Liver Transplantation Patients

病人或家屬在學習肝臟移植術後藥物過程中，多次反應藥物種類多、服藥時間複雜、兩單位護理人員指導方式不一，導致病人服藥錯誤。調查護理人員執行肝臟移植術後用藥指導完整性僅75.2%，而病人接受用藥指導整體滿意度僅77.2%，分析原因有：用藥指導工具缺乏、整合識藥圖卡使用不便、缺乏護理人員肝臟移植術後用藥指導指引、缺乏肝臟移植術後病人用藥指導流程及無持續性的用藥交班制度。故製作「新肝寶貝個人化用藥寶典」及護理人員肝臟移植術後用藥指引手冊、修訂肝臟移植術後用藥指導流程並建立持續性用藥交班制度，使肝臟移植術後病人用藥指導完整性由75.2%提昇為96.7%。顯示藉由整合用藥指導工具及流程，建立以病人為中心的用藥指導，確實使病人及家屬正確地安全用藥。

While learning the medications for post-liver transplantation patient, the patient and family members reported several times on the overwhelming diversity of drugs, complex medication schedule, and conflicting medication instructions from difference ward nurses. These factors have led to, in several instances, administration errors. After investigation, the comprehensiveness of the nurses' communicating of post-liver transplantation medical instructions was merely 75.2%, and the patient's satisfaction with medication instruction was 77.2%. Upon analysis, the following reasons were identified: insufficient medication instruction tools, inconvenient integrative pictorial medication instruction cards, inadequate post-liver transplantation medication instruction guide for nurses, absent post-liver transplantation medication instruction flowchart, and non-continuous medication handoff system. In response, the following nursing interventions were introduced: individualized medication instruction manual for post-liver transplantation patient, medication instruction manual for post-liver transplantation patient for nurses, modification to post-liver transplantation medication instruction flowchart, and continuous medication handoff system. The implementation of these nursing interventions successfully raised the comprehensiveness from 75.2% to 96.7%. The project demonstrated that, by building a patient-centered medication instruction on integrative medication instruction tools and flowcharts, can successfully reduce medication error of patients and families.