運用跨團隊合作提升住院病人PRN藥囑之給藥安全

Cross-Team Collaboration to Enhance the Safety of Inpatient Pro Re Nata Medication Orders

目的：住院病人的PRN藥囑（需要時使用），帶來臨床的便利性，但若給藥間隔過短或給藥量與長期用藥相加超過每日最大劑量，會是潛在的病人安全問題。

方法：運用問題解決型找出四項真因：PRN藥囑調劑流程與長期藥囑相同、缺乏PRN藥囑再次給藥間隔時間檢核機制、給藥後未完成記錄缺乏提醒機制、缺乏 PRN 藥囑給藥總量檢核機制。

結果：住院PRN藥囑之護理給藥異常率改善前為0.85%，給藥錯誤零容忍，挑戰降至0%。改善後為0%。翻轉PRN藥囑調劑給藥流程，減少非必要的程序，住院PRN退藥率由87.7%降至3.6%，減少有形的藥袋列印、無形的作業成本。

結論：本次專案改善後成效良好推廣至體系醫院，持續優化與精進，運用資訊檢核、流程優化以提升醫療品質。

 

Objective: Pro re nata (PRN; “as needed”) medication orders for hospitalized patients offer clinical convenience. Nevertheless, short dosing intervals and dosages that, when combined with long-term medications, exceed the maximum daily dose may pose considerable risks to patient safety.

Methods: A problem-solving model was used to identify four root causes of PRN medication risks to patient safety: the use of the same dosing process for PRN and long-term medication orders, the lack of a mechanism to assess intervals between PRN medication administrations, insufficient reminders to ensure the completion of records following PRN medication administration, and the absence of a system to monitor the total dosage administered from PRN medication orders.

Results: The nursing administration error rate for inpatient PRN medication orders was 0.85% prior to the improvements, with a zero-tolerance policy for errors, aiming to reduce it to 0%. After the improvements, the error rate successfully dropped to 0%. The PRN medication order dosing process was revamped to streamline procedures by removing nonessential steps. Additionally, the return rate for inpatient PRN medications declined from 87.7% to 3.6%, reducing tangible bag printing costs and intangible operational expense.

Conclusion: The project yielded satisfactory results and has been promoted across all hospitals within the system for continuous optimization and refinement. Information verification and process streamlining are utilized to enhance healthcare quality.