降低骨科病人合併抗生素治療靜脈滴注給藥逾時率

Reducing the Overtime Rate of Combined Antibiotics Therapy with Intravenous Drip Administration for Orthopedic Patients

用藥安全是國際共同關注的醫品議題，抗生素給藥時間錯誤易導致感染治療失敗並增加抗藥性風險。現況調查骨科病人接受合併抗生素治療靜脈滴注給藥逾時率高達60.5%，導因為護理人員給藥過程頻繁被干擾中斷、護理人員給藥順序無一致性、抗生素滴注過程病人行為不正確、缺乏專科性常見抗生素用藥資訊、護理人員對抗生素注射及稀釋認知正確率低。專案小組經跨團隊合作，召集藥師及醫護同仁，藉由共同擬定給藥時段作業模式、建立「給藥中勿中斷」提醒機制、常用抗生素施打時間對照圖卡、抗生素注意事項對照表及點滴注射衛教指導等方案，改善後骨科病人合併抗生素治療靜脈滴注給藥逾時率由改善前60.5%下降至10.5%；護理人員對靜脈滴注抗生素治療特性認知正確率由改善前64.6%提升至100%，持續追蹤至2020年7月，給藥逾時率皆<24.2%，效果能持續維持；運用跨團隊合作建立完善教育制度及制定標準作業流程，可促進合併抗生素治療靜脈滴注給藥之安全性並提升骨科病人照護品質。

Medication safety is a critical quality of care issue that has garnered global attention. Inappropriate administration timing of antibiotics can lead to treatment failure and an increased risk of drug resistance. Current investigations indicate that the overtime rate of combined antibiotic therapy with intravenous drip administration in orthopedic patients is as high as 60.5%. Several factors contribute to this high rate, including frequent interruptions during the medication administration process, inconsistent medication administration orders, improper patient behavior during antibiotic infusion, a lack of specific information on common antibiotics, and nurses' low accuracy in knowledge regarding antibiotic injections and dilutions. To address these challenges, an interdisciplinary approach involving pharmacists, doctors, and nurses was implemented to develop an operation mode for medication administration. Specific strategies such as a ''No interruption during medication administration'' reminder mechanism, an antibiotic administration sequence control card, an antibiotic precautions comparison table, and hygiene education guidance for intravenous drip were introduced. After the implementation of these improvements, the overtime rate of combined antibiotic intravenous drip in orthopedic patients drastically reduced from 60.5% to 10.5%. Additionally, nurses' awareness of the characteristics of intravenous antibiotic treatment increased from 64.6% to 100%. Continued tracking and evaluation up to July 2020 showed that the over-time rate of intravenous drip administration remained below 24.2%, and the positive outcomes were sustained. The accuracy and quality of care for combined antibiotic administration with intravenous drip among nursing staff significantly improved. These efforts have resulted in enhanced medication safety, reduced treatment failures, and minimized the risk of drug resistance, ultimately contributing to better patient outcomes.