藥師判斷性服務於中醫領域實例分析

The Utilization of Cognitive Service for Traditional Chinese Medicine

前言： 判斷性服務是指藥師調劑時發現用藥可能的疑義，與醫師進一步聯絡討論後，修正處方並重新調劑的過程。過去的研究發現藥師判斷性服務可以減少醫療資源浪費、提升用藥安全性，以及開藥的準確性。因此，衛生福利部與藥師公會在台灣大力推廣判斷性服務到各級醫療單位。然而，目前仍沒有很好的研究，去評估判斷性服務在中藥調劑的使用情形。本研究藉由分析區域教學醫院的藥劑科資料庫，嘗試了解判斷性服務在中藥調劑的應用現況。方法： 本文分析統計台北市立聯合醫院仁愛院區2011-2016 年之藥劑科資料庫，選取中藥處方判斷性服務之案例，並依照台北市立聯合醫院藥劑部建立之AABBCC 編碼表，分析藥師所發現的疑似藥物治療問題（AA 碼）、藥師建議內容（BB 碼）、以及醫師的回應結果（CC 碼）分項進行分析。統計各分項內問題出現的次數、頻率、以及佔整體發生個案的比率。結果： 自2011 年至2016 年5 月底，本研究共收集了97 個案例。分析藥物治療問題發現異常劑量最為常見，其中劑量太低佔多數共44 例，劑量太高6 例。除此之外，常見錯誤包含給藥方式不正確共21 例，以及重覆用藥共12 例。藥師介入則以建議改變劑量最多共50 例，其次為建議改變用藥間隔25 例，以及建議暫時停用特定藥物12 例。醫師接受藥師的判斷性建議後，有47 例作出更改劑量的決定，另外有27例更改用藥間隔，停用藥物與更換另一種藥物則較少。結論： 藥師的判斷性服務在中醫領域仍剛起步，在藥師的協助與建議下，可以幫助中醫師減少可能的劑量、服法錯誤，增加用藥安全性並減少意外失誤。

Background: Cognitive service is that pharmacists swap medication may be doubts, and physicians further contact discussion, modify the prescription and readjustment process. Previous studies have found that pharmacist-based cognitive services can reduce the waste of medical resources, improve drug safety, and prescribe the accuracy. Therefore, the Ministry of Health and Welfare and Pharmacists Association in Taiwan to promote cognitive services to all levels of medical units. However, there is still no real study to assess the use of cognitive services in the case of Chinese medicine swap. In this study, by analyzing the database of pharmacy department of the regional teaching hospital, we try to know the application of judgment service in Chinese medicine dispensing. Methods: This study was to analyze the pharmacy department database of Taipei City Hospital from 2011 to 2016 and to select the case of prescription cognitive service. According to the AABBCC code table established by the Association of Chinese Pharmacists Association to analyze the suspected (AA code), pharmacist advice (BB code), and physician response (CC code). The frequency and frequency of occurrence of problems within each sub-item, and the ratio of the total number of cases. Results: From 2011 to the end of May 2016, 97 cases were collected in this study. Analysis of drug treatment problems Abnormal dose is the most common, which accounted for 44% of the total dose is too low, the dose is too high in 6 cases. Also, the common types of errors include 21 cases of incorrect administration and 12 cases of repeated drug use. Pharmacists involved in the proposed changes in the dose of a total of 50 cases, followed by the proposed change in drug interval in 25 cases, and the suggested time to disable specific drugs in 12 cases. After the physician had accepted the pharmacist's judgment, 47 had the decision to change the dose, and 27 had a change in medication interval, with fewer drugs and less. Conclusions: The pharmacist's cognitive service is still in the field of Chinese medicine. With the assistance and advice of the pharmacist, the Chinese medicine physician can reduce the possibility of taking wrong medication on dose, increase the safety of medicines and reduce the unexpected error.