透過ATC碼提升「同藥理重複用藥」檢核成效

Using ATC code to Improve the Efficiency of Therapeutic Duplicate Prescribing Drug Alerts

「同藥理重複用藥」定義為相似作用機轉藥物同時開立，臨床上除了沒有額外的治療效益外，也可能增加藥物不良反應風險。2020年本院門診系統陸續由舊系統升級為新系統，2021/4藥學部接獲數起病安通報事件，發現同藥理重複用藥在新版門診系統並無檢核功能，詢問原因發現醫師反應該訊息大多無參考價值且干擾處方開立，故新系統請資訊室移除該功能。為提升門診「同藥理重複用藥」檢核效益，本研究針對現行同藥理重複用藥檢核流程進行分析，發現以下問題：（1）同成分不同劑型藥物轉換也會提示；（2）同藥理檢核無院方具強制力單位認可；（3）臨床科無新增同藥理檢核群組的管道；（4）建置新進藥品需花費許多時間且可能有疏漏。後續提出三個對策群組進行改善，分別為：（1）藥學部從藥性改為國際通用的ATC碼進行同藥理群組建檔；（2）設計新的資料庫並增加劑型欄位；（3）藥品開立管理小組專案列管。進行改善措施後，本研究結果分別有（1）同藥理重複用藥疑義處方件數：由每月0.39件降至0件，目標達成率100%；（2）同藥理重複用藥不必要提醒佔比：由74.5%降至40%，目標達成率46.3%；（3）醫師修改處方佔比由8.5%提升至29.9%，目標達成率252%。由於執行成效良好，本院於2022/3/29沿用設定至住院同藥理重複用藥檢核，未來預計平行開展至體系醫院。本研究亦可符合醫策會醫學中心評鑑條文，可供有興趣之醫院機構做相關改善政策之參考。

Therapeutic duplicate prescribing is defined as the simultaneous prescribing of drugs with similar mechanisms of action, which may increase the risk of adverse drug reactions without therapeutic benefits. The outpatient system will be upgraded from the old system to the new one in 2020.In 2021/4, the Department of Pharmacy received several incidents of medical safety notification, and found that the new version of the outpatient system does not have the drug alerts of therapeutic duplicate prescribing. When asked about the reason, it was found that doctors responded that the information was mostly useless and interfered with the prescription process. Therefore, the new system asked to remove this function. In order to improve the efficiency of therapeutic duplicate prescribing in outpatient system, we analyze the current prescribing process and found the following problems: (1) the conversion of drugs with the same ingredient in different dosage forms will also be prompted; (2) no mandatory unit approval the list of therapeutic duplicate prescribing; (3) the clinicians have no way to add or modify the list of therapeutic duplicate prescribing; (4) the establishment of new drugs takes a lot of time and may be omissions. Subsequently, the following countermeasures were proposed for improvement, namely: (1) the Department of Pharmacy changed the drug properties to the internationally accepted ATC code to form a file with the list of therapeutic duplicate prescribing; (2) design a new database and increase dosage form column; (3) the list of therapeutic duplicate prescribing managed by the Drug Prescribing Management Team. After the improvement measures were taken, the results of this study were: (1) the number of suspicious prescriptions for therapeutic duplicate prescribing: from 0.39 to 0 per month, the goal achievement rate was 100%; (2) the proportion of unnecessary reminders for therapeutic duplicate prescribing: from 74.5% to 40%, the target achievement rate was 46.3%; (3) The proportion of physicians modifying prescriptions increased from 8.5% to 29.9%, and the target achievement rate was 252%.Due to the good results of implementation, the hospital will continue to use the same setting as inpatient therapeutic duplicate prescribing drug alerts on 2022/3/29, and it is expected to be carried out in parallel to system hospitals in the future. Our study can also meet the evaluation provisions of the Medical Policy Association Medical Center, which can be used as a reference for interested hospital institutions to improve their policies.