運用品管圈的實施以提升住院病人自備藥物審核之成效

Using the Quality Control Circle to Enhancing the Efficacy of Reviewing Hospitalized Patients’Own Medications

目的：回顧本院住院自備藥審核紀錄，每月約450筆住院自備藥處方，平均約有38筆藥師未核出之疑義處方，約佔總自備藥疑義處方之34.5%。結果顯示，住院自備藥審核的成效仍有進步空間，故運用品管手法（問題解決型），重新檢視住院自備藥審核流程，提升住院自備藥物審核成效。
方法：利用回溯性研究方法蒐集樣本並運用品管手法找出六項真因，並擬定四項對策。以圈能力設定目標為0.64%，比較改善前（民國108年1月至109年3月）、改善中（民國109年6月至9月）、改善後（民國109年10月至12月）的住院自備藥物審核疏失率，評估住院病人自備藥審核成效是否有提升。
結果：改善後，住院自備藥相關之審核疏失率（住院自備藥相關之審核疏失件數/總住院自備藥處方）由1.3%減少至0.46%，進步率64.6%，目標達成率127.3%。
結論：住院自備藥物不僅可以整合病人住院以及慢性病用藥，確保病人用藥連貫性，每年還可省下約500萬元藥費。透過流程改善，藥師執行住院自備藥審核可透過明確的審核標準進行處方評估，針對急迫性的處方問題，於第一時間與醫師聯絡，加強把關病人用藥安全。

Objective: On reviewing the prescriptions of hospitalized patients’own medication (HPOM) in our hospital, we determined that there were approximately 450 HPOM prescriptions per month, of which, an estimated 38 prescriptions were considered inappropriate as they were not verified by pharmacists; this number accounted for roughly 34.5% of the total inappropriate prescriptions for HPOM. These results indicate that pharmacists need to improve the efficacy of reviewing HPOM. To achieve this, we used the quality control circle to renew the process.
Methods: This is a retrospective study. We used the Quality Control method to recheck the actual causes. We finally found six true causes, made four strategies, and set 0.64% as a goal. Further, to evaluate whether the efficacy of reviewing HPOM had improved, we compared the rate of negligence in reviewing HPOM before (Jan. 2019 to Mar. 2020), during (Jul. to Sep. 2020), and after (Oct. to Dec. 2020) the study.
Results: After this improvement, the rate of audit negligence associated with HPOM decreased from 1.3% to 0.46% (the among of audit negligence associated with HPOM /The total HPOM prescriptions), with a progress rate of 64.6%, and an achievement rate of 127.3%.
Conclusions: Using HPOM not only rectifies patients’medications to ensure medication reconciliation but also saves approximately NT$5 million in drug costs each year. Through improving the process, pharmacists can use the clear criterion to review HPOM prescriptions. For urgent problems, pharmacists should contact doctors immediately. In summary, following the proposed approach, the medication safety of patients can be improved.