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| 題 名 | Improving the Quality of Medication Reconciliation for Admission Patients Using HFMEA and NHI-PharmaCloud=利用HFMEA及健保雲端改善新入院病人的用藥整合結果 |
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| 作 者 | 李紀慧; 林姝佑; 郭孟璇; 陳怡秀; | 書刊名 | 醫務管理期刊 |
| 卷 期 | 18:3 2017.09[民106.09] |
| 頁 次 | 頁231-251 |
| 分類號 | 419.39 |
| 關鍵詞 | 藥品治療連續性; 住院病人安全; 醫療照護失效模式及效應分析; Medication reconciliation; Inpatient safety; HFMEA; |
| 語 文 | 英文(English) |
| 中文摘要 | 目的:本研究藉由醫療照護失效模式及效應分析改善新入院病人用藥整合流程。方法:以重複性橫斷式觀察實施介入前、中、後開立醫囑錯誤率之變化。介入的措施為應用資訊系統改善風險指數最高步驟,藥師可以利用電腦用藥整合系統判斷處方準確性。藥師對入院病人藥物治療史共評估5,771次且提供處方建議。主要評估介入前後6個月的風險指數及處方錯誤率。次要觀察指標為新入院病人用藥準確性。結果:共10個失效模式風險指數最高。6個月後風險指數平均下降57.5%,處方錯誤率從0.016%降至0.011%(p = 0.005);其相對危險值為0.69(95%CI:0.54-0.90),入院前用藥準確性從6.7%提高到80%(p <0.001)。結論:HFMEA確實可以評估醫療照護過程中的潛在風險且作為改善用藥治療連續性的輔助工具。 |
| 英文摘要 | Objectives: In this study, Healthcare Failure Mode and Effect Analysis (HFMEA) was integrated with medication reconciliation to achieve better outcomes. Methods: A repeated cross-sectional study design was used to observe changes in computer-prescribed order error rates six-months prior to, during, and following the implementation system. The intervention consisted of an IT application designed to improve highest hazard score steps. To judge the accuracy of the prescription, participating pharmacists were given access to the computerized medication reconciliation system. Pharmacists assessed the medication history of admitted patients 5,771 times and provided prescription recommendations. The hazard score and the rates of prescription errors before and six-months after the intervention were primary evaluated. The secondary outcome was the medication accuracy rate among admission patients. Results: Ten failure modes with high hazard scores were identified in the inpatient admission processes. After six months, the mean hazard score decreased 57.5%, the rate of prescription errors decreased from 0.016% to 0.011% (p = 0.005), the relative risk ratio before and after system data was imported from NHI-PharmaCloud to the Hospital Information System was 0.69 (95% CI: 0.54-0.90), and the accuracy of pre-admission medications increased from 6.7% to 80% (p < 0.001). Conclusions: HFMEA should be used to evaluate potential risk in healthcare processes and be used as an adjuvant tool to improve implementation of medication reconciliation. |
本系統中英文摘要資訊取自各篇刊載內容。