降低中醫病房病人中藥廢棄發生率之改善專案

The Improving Project to Decrease the Waste Rate of Chinese Medicine in Chinese Medicine Wards

本專案旨在降低中醫病房病人中藥廢棄發生率，專案動機係由病人多支出醫療費用之抱怨所引發，經調查發現中藥廢棄原因為病人病情改變停用中藥、中藥調劑時間受限，使醫師多開立視需要時(Pro Re Nata, PRN) 藥囑、中藥局將多日處方一次調劑、中藥經調劑及煎煮後無法退藥、醫師開立中藥前未說明治療目的、護理師協助病人服用藥物正確性低、中藥包裝無藥名、給藥途徑標示、病人將口服及外用煎劑混淆等問題，於2013 年11 月1 日至2014 年2 月28 日，跨部門推行每日中藥調劑資訊化作業、研發中藥包裝藥名、給藥途徑標示及外用中藥盛裝器具、規劃假日及夜間中藥調劑時間、修訂中藥煎劑給藥流程及推行住院診療計畫作業等措施介入後，中藥廢棄發生率由4.2% 降至1.4%，改善幅度達66.7%，專案改善經驗可提供護理人員應用及平行推展於臨床工作中，以降低病人中藥廢棄發生率。

The purpose of the project is to decrease the waste rate of Chinese medicine in Chinese medicine wards. The motivation is due to some patients complaining about excessive medication expenses. Through surveying we found some reasons as the following: patient’s condition changed and discontinued use Chinese medicine; traditional Chinese physicians prescribed pro re nata (PRN) orders because of the limited time to dispense; Chinese medicine pharmacy dispensed multiple-day prescription at one time; Chinese medicine could not be returned after dispensing and decocting; traditional Chinese physicians prescribed Chinese medicine without describing the purpose of treatment;low accuracy when nurses assisting patients take medicine; no content and route of administration labeled on herbal packages; patients confused about external use or oral use medication. From 11/01/2013 to 02/28/2014, after some cross-department measures, including carrying out informationalization projects for daily Chinese medicine dispensing ; developing contents and routes of administration labels on herbal package; making containers for external-use Chinese medicine;scheduling dispensing time at night and on holidays;revising the decocting and prescribing Chinese medicine procedures, and carrying out treatment-plan projects, the waste rate of Chinese medicine decreased from 4.2% to 1.4%, a 66.7% improvement rate. The improving project experience provides the opportunity to of reducing the waste rate of Traditional Chinese medicine in clinical settings.