跨專業環環相扣守護安全用藥——以住院藥品管理為例

「臺灣病人安全通報系統」2017年年報資料顯示，國內醫療機構通報之異常事件以藥物問題為最大宗，而「人為」與「溝通」是重要因素。本文以涵蓋層面多元的住院藥品供應為例，從機構處方集的藥品品項評選與採購、藥品儲存、處方開立、調劑作業、給藥作業，到用藥後之藥品療效與不良反應監測及異常事件通報等，分階段探討醫療機構之藥品管理與使用，並闡述各階段之工作要旨，說明相關專業各別擔負的職責或可扮演的角色，期有助各司其職，共同確保「有藥用」且「用對藥」。整體而言，醫療機構之藥品供應與管理事務複雜，不僅流程涵蓋多重步驟，管理與使用更牽涉到行政單位與醫療團隊多樣專業，值得相關成員共同關注與瞭解，而以教育訓練強化醫療人員之守護用藥安全認知與增進專業人員間之良性互動與協同合作，在合宜措施與及時推動下，共謀奠立可長可久安全用藥體系。 The majority of patient safety incidents cited in the latest Taiwan Patient Safety Reporting System Annual Report were medication-related, with human factors and communication issues identified as the key underlying causes of these incidents. Focusing on inpatient settings, the complex yet multiprofessional-linked drug supply scheme currently in place in medical institutions in Taiwan is described, with the aim of facilitating the accessibility and appropriateness of medication use by detailing the responsibilities of each professional role. Institutional medication management and use comprise several sequential and interconnected stages, including formulary management and drug procurement, medication storage, physician prescribing, pharmacist dispensing, nurse administration, and efficacy-and-safety monitoring and reporting. The principal tasks and personnel duties at each stage are addressed. In summary, institutional drug distribution and control is an intricate process that involves multiple processes and a diverse array of professionals and administrative staff. It is imperative to actively engage the relevant parties, especially through in-service training, in order to understand their essential roles and responsibilities and to enable communication and collaboration among stakeholders in the drug distribution chain. Implementing the appropriate initiatives in a timely manner will help establish an effective and robust safe-medication-use system.