門診病患用藥安全的認知－－以北部區域級以上醫院為例

Cognition of Drug Safety in Outpatient-Regional Hospital vs. Medical Center in Northern Taiwan

提升病人安全、降低醫療錯誤是近年來世界衛生組織及歐美國家最受重視網的議題，台灣亦不落人俊，自民國92年起，成立「病人安全委員會」，負責統整推動病人安全議題，減少醫療疏失以改進醫療品質，也成為醫務管理與醫療政策中極為重要的一環。病人安全的首要目標就是提升病人用藥安全，若要達成此目標除了須仰賴醫療人員與民眾之間的互相溝通與合作，患者本身更應加強用藥安全的認知，進而具備安全用藥的行為。因此，本研究選擇在提升醫療品質績效顯著並具有專責部門管理的北部兩家區域層級以上的醫院作為調查地點，從該門診病患本身的角度來調查醫療院所的用藥安全，以及病患本身對用藥安全的認知與用藥安全行為的落實程度。本研究以北部區域醫院以上的院中門診病患為封象，針對用藥咨詢、醫病溝通、藥袋標示、領藥確認、服藥安全行為與藥品存放等用藥安全的項目，以問卷方式進行調查，共發放400份，有效問卷回收400份。結果發現：1.病患封醫院提供用藥咨詢、觀察醫療人員用藥安全行為與藥師回應患者咨詢的滿意度比率都不高，皆不到六成。2.依病患特質來看，女性、31歲以上者及就醫次數為3~10者在事前醫病溝通行為顯著較高，領藥後，高中職以上者會確認藥物，而31歲以上者藥品存放的觀念較好，同時51歲以上者較為注意服藥的安全行為。3依醫院等級來看，就醫於醫學中心者在醫病溝通、領藥確認、提供用藥咨詢滿意度及觀察醫療人員用藥安全行為上皆比區域藥院來得好。安全的就醫環境及安全有效又無藥害的藥物治療是一般民眾期待的目標，未來應有更多資源投入用藥安全的研究，建立更周延的安全作業體系，並結合電腦輔助系統，於事前防止任何錯誤的發生，以確保病人用藥安全。

Medication safety is a primary component of a comprehensive safety program and an integral part of quality patient care. The most important issues for WHO, European countries, or US are promotion of the patient safety and diminishing medical error. It is also the main emphasis on healthcare administration in Taiwan. The first aim of patient safety is to elevate the drug safety. The goal can be accomplished not only in the good connection and cooperation of patient and medical staff, hut also in the enforcement of drug safety knowledge and proper behavior of taking drug for patient. To address the public health problem of outpatient drug safety, we investigated the perception of drug safety, behavior, patient-medical professionals communication and, from the patient's point of view, the fulfillment of drug safety in medical staff. One medical center and one regional hospital in northern Taiwan were chosen as the survey targets, for their outstanding record in promoting medical quality and specific management department in charge with relative affairs. We investigated six main categories of drug safety by delivering 400 questionnaires, which included the inquiry of drug usage, patient-medical professionals communication, the labeling on drug bag, confirm processes during having drug, the accuracy in taking drug and the storage of drug. Our results show that: 1. The satisfaction for drug inquiry of hospital, the drug safety behavior of medical staff and the service of pharmacist were below 60%. 2. Female, those who were above 31-year, or who had medical service for 3~10 times past half year have the better patient-medical professionals communication. Higher educated patient would double check the medicine information from the pharmacy. When taking the medicine, older patients (＞51 years old) were more careful and correct. 3. The execution of drug safety policy by staff in medical center was significantly better than that in regional hospital. The expectations of patient were a safer medical environment, as well as effective and harm-free medication. To assure safe therapy, the following should be addressed: first, more financial aid should be provided for the study of medication, and second, hospitals should provide drug consultation for patient, and make sure that patient have access to the full facts of understanding drug safety. The intervention of the aid of complementary computer system will help conceptualize patient drug safety, and establish an accurate drug delivery and recording system for preventing medical staff from any possible artifacts beforehand.