住院管灌病人被不當磨粉給藥之醫療耗用與省思

Inappropriate crushing of controlled-release medications in enteral-feeding inpatients: medical utilization and considerations

目標：本研究旨在探討國內住院管灌病人被不當磨粉給藥之現況，主要標的是「控制釋放錠」，並以「藥費」計算其衍生出的醫療耗用情形，籲請醫療人員的重視。方法：利用全民健康保險研究資料庫之「全民健保處方及治療醫令明細檔―住院」，統計分析2016年1月1日至2020年12月31日期間健保特約醫事機構中裝有鼻胃管病人，且於住院期間醫師有處方控制釋放錠的藥費。結果：住院管灌病人被不當磨粉的藥費5年總計約為10,976萬元，平均每年約2,195萬元。藥物被不當磨粉的鼻胃管插管人數占鼻胃管插管總人數之比率，五年平均約為52.8%，即有一半以上的插管病人都有藥物被不當磨粉之情事。結論：錠劑被不當磨粉的作業，古今中外一直存在，然因而造成不確定療效及安全性的後果及醫療浪費，卻顯然被忽視。倘醫療人員對於藥物不當磨粉給藥的認知不足，帶來的將會是對病人的治療失當及醫療糾紛，不可不慎。期盼藥商、醫事人員、藥物管理機關能共同合作，對醫療品質及病人安全進行把關。

Objectives: This study investigated the current situation of inappropriate crus hing of controlled-release tablets among hospitalized patients receiving enteral feeding in Taiwan. Moreover, the study evaluated the associated medical expenses, calculated on the basis of“medication costs,”to raise awareness among health-care professionals. Methods: Using data from the National Health Insurance Research Database, specifically the National Health Insurance Prescription and Treatment Details—Inpatient, the study analyzed medication costs for patients with a nasogastric tube (NGT) who were prescribed controlled-release tablets during their hospitalization at National Health Insurance–contracted medical institutions between January 1, 2016, and December 31, 2020. Results: Over the 5-year period, the total medication cost resulting from inappropriate crushing of controlled-release tablets was approximately NT$109.76 million, with the average annual cost being NT$21.95 million. Approximately 52.8% of NGT patients received improperly crushed medications, indicating that more than half of such patients experienced inappropriate medication administration. Conclusions: The improper crushing of tablets remains a persistent global concern, resulting in uncertain therapeutic efficacy, safety concerns, and medical waste; nevertheless, this issue is often overlooked. Inadequate awareness among health-care professionals regarding the risks of inappropriate medication crushing may lead to suboptimal treatment outcomes and potential medical disputes. Accordingly, health-care providers, pharmaceutical companies, and regulatory authorities must collaborate to ensure health-care quality and patient safety.