臨床藥師參與內科加護病房照護之成效評估

Evaluation of Clinical Pharmacist Interventions in an Medical Intensive Care Unit

美國重症醫學會指出，藥師為重症照護團隊中重要的角色之一，藥師的加入可以預防藥物不良事件之發生、提升患者用藥安全性、並且降低不必要的藥費支出。本研究評估院內於103 至105 年間，臨床藥師參與加護病房醫療團隊聯合巡診進行藥事服務之成效，針對用藥相關建議進行分析，包含：用藥適當性、藥物劑量、劑型、交互作用等。研究期間，藥師共主動提出356件用藥建議，醫師平均接受率為88.6%，用藥建議以劑量和頻次佔最多（21.2%），其次為藥物劑型（17.6%）與重複用藥（15.4%）。另外，藥師的介入可達到減少藥費之目的，以健保給付價計算，共可節省 244749 元，藥費節省最多的藥物種類是抗感染製劑。臨床藥師成為重症醫療團隊的一員，可降低開方疏失與促進患者用藥安全，增加患者的照護品質。

The Society of Critical Care Medicine (SCCM) states the important role of pharmacists in critical care teams. The involvement of pharmacists can prevent adverse drug reactions, improve patient safety, and reduce the costs of unnecessary drug therapies. The study was carried over the period from 2014 to 2016. The drug-related problems (DRPs) suggested by clinical pharmacists who participated in the intensive care unit (ICU) healthcare team were analyzed, including the appropriateness of medication, dose and dosage form of drugs, and drug interactions. During the study period, the clinical pharmacists made a total of 356 pharmaceutical recommendations, of which 88.6% were accepted by medical professionals. The most common problem found was related to the dose and frequency of drugs (21.2%), the dosage form (17.6%), and duplicated medication (15.4%).Otherwise, interventions of pharmacists had a positive impact on the cost saving of drug therapy. The recommendations made during the study period accounted for NT$244,749 in cost savings (based on amount reimbursed by health insurance), the majority of which were savings on antibiotics. As part of critical-care multidisciplinary teams, clinical pharmacists can decrease the rate of medication errors, improve the safety of medication, and provide quality care to patients.