資訊管控系統對管制藥品Painkyl處方開立之影響評估

Evaluation of the Impact of Information Management System on the Prescription of Painkyl

Painkyl（fentanyl）屬鴉片類之口頰溶片用於癌症突發性疼痛。對鴉片類藥物不耐者具呼吸抑制且有致死案例，故不可單獨使用需搭配日夜連續型之鶻片類藥物。因此本醫院於2020年6月資訊管控鎖開立Painkyl須併用類鴉片且PRN開立次數不應超過56次。本研究目的在於探討資訊阻檔對臨床醫師處方行為影響並驗證系統是否確實阻擋不符規範之處方。經門急診處方資料推算系統上線前半年有效與當筆處方未併用類鴉片為3筆（1.91%），PRN次數＞56次為6筆（2.87%），相較於國外文獻5.6％不具鴉片耐受性者低，可能為系統無檢核劑量低估未併用情形。系統阻擋16筆不當處方以未併用類鴉片居多（14筆），資料驗證後確實有效阻擋，資訊系統能100％阻擋且補強槩師人工審方遺漏之可能（1.91%）以提高處方開立安全性。同時透過資訊系統提醒醫師併用類鴉片之安全性與PRN次數上限。

Painkyl (fentanyl) is an opioid orally disintegrating tablet used for breakthrough cancer pain. Respiratory depression and fatal cases have been reported in intolerant to opioid analgesics. Therefore, it should not be used alone and should be combined with around-the-clock opioid analgesics. In 2014, Shakir found that 5.6% of users of Painkyl lacked opioid tolerance. In 2015, Cahil found inappropriate usage behaviors, such as 30% being used in non-cancer patients, 44% having less than 60 mg of morphine daily, and 50.2% exceeding four doses per day. In June 2020, an information control lock was implemented in Hospital, allowing Painkyl prescriptions only in combination with other opioids, with a limit of 56 as-needed (PRN) prescriptions. This aim of this study is to investigate the impact of information blocking on prescribing behavior by clinicians and validate whether the system effectively prevents non-compliant prescriptions. Based on the data from the ER/OPD prescriptions, in the six months before the system went online, 3 prescriptions (1.91%) were deemed valid without combining with other opioids, and 6 prescriptions (2.87%) exceeded the PRN limit of 56. This rate is lower than the 5.6% reported in foreign literature for those lacking opioid tolerance, possibly due to the system not checking for cases of underestimating doses without combination. The system blocked 16 inappropriate prescriptions, with the majority (14 prescriptions) being without combining with other opioids, which was confirmed to be effectively blocked after data verification. The information system demonstrated 100% effectiveness in blocking and reinforcing the possibility of pharmacist oversight (1.91%), thus enhancing prescription safety. Additionally, the information system serves as a reminder to physicians regarding the safety of combining with other opioids and the PRN limit.