運用藥品離櫃系統提升血液製劑批號登錄完整率

Using the System of Drug Out-of-Cabinet to Improve the Registered Rate of Batch Numbers for Blood Products

本醫院（南區某醫學中心）血液製劑批號登錄採紙本作業，藥師有時會遺漏登錄導致無法確保每筆資料完整記錄。109年7月衛生主管機關公告，血友病藥品（屬血液製劑）申報費用批號為必填欄位，未填直接核扣進而影響醫院收入。另外，當某血液製劑之某批號須回收時，登錄紀錄不完整將不易追蹤流向且耗時。故本研究期望透過醫院資訊系統介入提高血液製劑批號登錄完整率與縮短後續批號追蹤時間。透過詢問藥師實際作業流程得知批號登錄完整率低原因並進行整體性評估後，採用以下四項方案進行改善：（1）導入條碼自動帶入資料、（2）病人資訊結合藥品離櫃系統直接帶入、（3）建置資訊系統結合藥品離櫃系統自動鎖定品項，需輸入批號才能進行離櫃、（4）廢除紙本登記本，利用電腦作業登錄。本研究成功地將血液製劑批號登錄步驟加入藥品離櫃作業中，以確保每月上傳至健保署血液製劑批號之完整性，並提供查詢功能作為藥品受汙回收公告時，即時查詢特定批號使用。其中使用量最大之Albumin批號登錄完整率由53.5%至大幅上升至97.3%。模擬後續Albumin批號追蹤時間由111分鐘降至59分鐘。本研究確實有效提高血液製劑批號登錄完整率與提升藥師對此批號登錄作業之滿意度，並相對地縮短後續批號追蹤時間，可做為其他醫療院所參考學習。

The registration of batch numbers for blood products in the Hospital was implemented on paper. When dispensing these specific medications, hospital pharmacists sometimes omit to record the data to make it incomplete. In July 2019, National Health Insurance Administration (NHIA) announced that the batch number of hemophilia drug for application fee was the required field, and if it is not filled in, it will be directly deducted and would affect the hospital's income. In addition, when a certain batch of a blood product must be recalled, the incomplete record would make it difficult to track the flow and time-consuming. Therefore, this study hopes to improve the registered rate of batch number for blood products and to shorten the batch number tracking time through the intervention of the Hospital information system. After asking the Hospital pharmacists about the actual operation process, we found the reasons for the low registered rate of batch numbers and made an overall assessment to adopt the following four projects to improve: (1) importing barcodes to automatically bring in data, (2) combining patient data with the drug out-of-cabinet system to directly bring in, (3) building an information mechanism to automatically lock specific items, and need to input the batch number to finish the out-off process; (4) abolishing the paper writing, and using the computer to record. In this study, the process of batch number registration for blood products was successfully added to the drug out-of-cabinet operation to ensure the integrity of the batch number registration for blood products uploaded to NHIA every month, and the query function was provided as a drug contamination recall announcement to instantly query the specific batch number for use. The complete registration rate of Albumin batch number, which is the most used, has increased significantly from 53.5% to 97.3%. The simulation follow-up Albumin batch tracking time was reduced from 111 minutes to 59 minutes. This study can effectively improve the complete rate of batch registration for blood products and improve the satisfaction of hospital pharmacists with this batch registration operation, and relatively shorten the follow-up batch tracking time, which can be used as a reference for other medical institutions.