縮短化療專區病人首日等候化療給藥時間

Reducing wait time for Chemotherapy Administration on the Patient’s First day of Chemotherapy

目的：化學治療在腫瘤治療中占有重要角色，而其處方複雜，多數為多種藥品組合，從醫囑開立、藥師調配、人員輸送及護理給藥端存在許多流程浪費，專案目的縮短住院等待化學治療時間，減少病人等候抱怨，進而提高化學治療滿意度。
方法：經現況統計化療醫囑開立至化療藥物開始滴注所需等候時間平均279分鐘，進行原因分析：主治醫師門診/查房/解釋病情，未能及時覆核化療醫囑、病人不知道自費化療藥流程影響配藥時間、首日療程所有藥物配置完成才盒裝。解決方案：一、重新修訂化療醫囑開立流程；二、簡化自費化療藥物流程；三、優先調劑標靶/免疫藥物等介入措施。
結果：首日等候化學藥物平均等待時間為165分鐘，較改善前279分鐘，共縮短114分鐘，顯示本專案成效超越預期目標。
結論：專案實施過程中因跨多團隊，協調與修定化學治療病人住院作業流程，會議中各項解決辦法需團隊中各成員協助，因獲得院方、醫療事務組與護理部支持，並推展至其他專科執行化療之病房，同步增進化療病人的滿意度。

Purposes Chemotherapy plays a vital role in oncology treatment, in which chemotherapy prescriptions are complex and are mostly comprised of multiple therapeutic agents. There are many inefficiencies process, from chemotherapy order issuance by physicians, drug dispensing by pharmacists, medication delivery by healthcare personnel, and chemotherapy administration by nurses. The purpose of this study was to shorten the wait time for chemotherapy administration in the inpatient setting, reduce patient complaints about long wait times, and improve patient satisfaction.
Methods After analyzing the current statistics, we found that the average wait time from the issuance of the chemotherapy prescription to the commencement of chemotherapy infusion was 279 minutes. The reasons for prolonged wait times included the attending physicians were at outpatient clinics, ward rounds, explaining patient medical conditions, and failure to review the chemotherapy drug orders in a timely manner. Furthermore, patients were sometimes unaware that elective chemotherapy procedures would affect dispensing times, and all the drugs required for the first course of chemotherapy being only packed upon dispensing. We adopted the following solutions: 1. revision of the process of issuing chemotherapy orders; 2. simplification of elective chemotherapy procedures; and 3. prioritization the adjustment of targeted therapy, immunotherapy drugs, and other interventions.
Results In comparison with the original wait time of 279 minutes, the average wait time on the first day of chemotherapy was shortened to 165 minutes, which was a reduction of 114 minutes and surpassed the expectations of the effectiveness of this study.
Conclusions During the study implementation, multiple teams were involved in coordinating and revising the hospitalization workflow for patients on chemotherapy. The solutions that were proposed during the meetings required the assistance of all of the team members, and with the support from the hospital, the medical affairs team, and the nursing department, the solutions were extended to other specialized chemotherapy wards. This simultaneously improved the satisfaction of patients on chemotherapy.