頁籤選單縮合
題 名 | 藥師參與抗生素管理計畫成效初探=The Role of the Pharmacy Service in the Antimicrobial Stewardship Program |
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作 者 | 陳立洳; 蘇麗婷; 林梅芳; | 書刊名 | 藥學雜誌 |
卷 期 | 32:1=126 2016.03[民105.03] |
頁 次 | 頁12-17 |
分類號 | 418.281 |
關鍵詞 | 抗生素管理計畫; 資訊化管理; 藥師; Antimicrobial stewardship program; Pharmacy service; Computerized physician order entry system; |
語 文 | 中文(Chinese) |
中文摘要 | 自2013年起衛生福利部疾病管制局開始推展「抗生素管理計劃」,期能透過本計 劃推展,減少多重抗藥性細菌的發生率及提升病人治療成效。本院自2014年01月起加 入本計劃,並於當年05月起建置抗生素管理資訊平台。期能透過資訊化系統,提升藥 師抗生素管理之有效性與及時性,達到提高抗生素合理使用的目的。方法:一、院內 推動抗生素計畫,以平衡計分卡 (BSC) 之績效管理模式定訂策略目標;二、藥師參與 開發抗生素劑量輔助系統:包含自動計算病人之 eGFR 並提供適當之建議劑量、建構 藥師評估抗生素適當性的平台、即時回饋建議給處方開立醫師之簡訊功能及自動產出 指標的報表功能;三、藥師參與跨團隊抗生素管理小組;四、舉辦抗生素管理教育訓 練;五、建置評/稽核機制,定期評估檢討,具體呈現改善成效。成效:一、藥師協助 審核住院病人後線抗生素處方24小時內評估率成長2.89倍 (26.03% vs. 75.14%);住院病 人管制性抗生素處方疑義比率,由計畫參與前的每月平均15.7%下降為7.3%;住院病 人管制性抗生素疑義處方評估建議醫師接受率成長1.77倍 (53.7% vs. 94.8%);二、藥師 參與提出一項抗生素劑量輔助系統改善計畫;三、辦理藥師抗生素管理教育訓練課程 共3場,計3.5學分;藥師課程內容瞭解程度成長38.9%(67.4% vs. 93.6%);課程整體滿 意度達97.6%。藥師完成3堂疾病管制署抗生素管理數位學習課程比率為63.6%,所有 藥師課後測驗皆高於80分。四、進行民眾抗生素用藥宣導講座與衛教等活動,平均2.7 場/月,累計109人次,衛教前後課程瞭解度成長10.5%(81.6% vs. 92.1%),平均滿意度 94.4%。結論:藉由藥師參與院內抗生素管理,建置抗生素資訊管理平台,提高醫師 感染症治療性抗生素使用建議準則遵循率、藥師抗生素管理之有效性與及時性,達到 有效管理抗生素合理使用,降低病人抗生素抗藥性之發生,及減少醫療資源耗用。 |
英文摘要 | The Centers of Disease Control, R.O.C. has implemented the Antimicrobial management program, known as antimicrobial stewardship program (ASP) in the healthcare institutions since 2013. ASP involves a systematic approach to optimising the use of antimicrobials, reduce adverse consequences of antimicrobial use (including antimicrobial resistance, toxicity and unnecessary costs), and improve patient outcomes. This paper aims to reveal the pharmacy service in ASP and its outcome after this intervention. Methods:(1) Effective implementation of ASP: The Balanced Score Card (BSC) has been used to establish the goals of ASP 2015. The Key Performance Indicator (KPI) has been used to measure the performance of ASP. The audience has been targeted to review the outcome. (2) Developing the computerized physician order entry (CPOE) system. The CPOE system comprises the formulary and antimicrobial approval system, which facilitates restriction of board-spectrum antimicrobials to patients where use is clinically justified. (3) Setting up the Antimicrobial Stewardship Committee: The committee members include clinicians, pharmacists, medical laboratory scientist, nursing staff, and IT technician. The key responsibility of this committee is to develop the guidelines of antibiotic usage, implement this program, and evaluate the outcome. (4) Conducting education program: Host internal training programs for healthcare providers regularly to enhance their concepts of ASP and their competencies. All health professionals have been involved in this educational program on antimicrobial stewardship. (5) Auditing and evaluating the performance regularly. Results:(1) The percentage of prescriptions reviewed by pharmacists is increased 3.68 times, and its retrospective reviewing rate with 24 hours was over 70%. (2) The pharmacists have implemented one PDCA program. (3) The education for pharmacists has been hold for 3 times this year. (4) There were 2.8/per month educational activities for the public have been conduct by the pharmacists. Conclusions:Pharmacists are essential to the success of the hospital ASP, and have a positive effect on improving appropriate antimicrobial use, patient care and safety. Therefore, the antimicrobial stewardship team should include a pharmacist who has experience or is trained in antimicrobial stewardship, and who is allocated time and resources for antimicrobial stewardship activities. |
本系統中英文摘要資訊取自各篇刊載內容。