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系統識別號 U0026-0812200913552511
論文名稱(中文) 合理調劑量與藥事服務品質之探討
論文名稱(英文) The Assessment of Pharmacy Personnel and Good Pharmacy Practice
校院名稱 成功大學
系所名稱(中) 臨床藥學研究所
系所名稱(英) Institute of Clinical Pharmacy
學年度 95
學期 2
出版年 96
研究生(中文) 張家嫺
研究生(英文) Chia-Hsien Chang
電子信箱 b90403008@ntu.edu.tw
學號 s6694103
學位類別 碩士
語文別 中文
論文頁數 143頁
口試委員 口試委員-蔡瑞真
口試委員-張有恆
指導教授-高雅慧
指導教授-林素真
指導教授-張慧真
中文關鍵字 合理調劑量  藥事人力  藥事服務  用藥安全 
英文關鍵字 Workload  Pharmacy practice  Medication safety  Pharmacy personnel 
學科別分類
中文摘要 背景:對於醫療人員而言,安全為提供醫療服務之首要條件。就藥師而言,單位時間內的處方量愈多,將導致評估處方的時間愈少,用藥疏失的風險會增加。根據文獻,繁重的工作量亦導致未偵測到的調劑疏失的發生,而藥師人力短缺是增加用藥疏失的潛在因素。
目的:建立臺灣各醫院層級合理的門診藥事調劑服務量,並得出影響調劑作業時間之因素。
方法:本研究為橫斷性研究,以民國90至93年度醫院評鑑暨教學醫院評鑑合格名單,於地區醫院以上之執業藥師為研究對象,依處方性質分為一般處方、磨粉處方及照會處方,實地測量依據標準操作程序所花費的時間。定義完成90%處方之時間為合理調劑時間,將處方量依性質做比例換算,利用工時估算每位藥師每日調劑之合理處方量,進而推估合理門診藥事人力。並利用問卷調查標準操作程序於藥事服務現況執行率,若執行率不到60%,則進而分析限制執行因素。本研究採用描述性統計和多元線性迴歸推估合理調劑量時間與影響調劑作業因素。
結果:本研究共收集1452張有效實測處方及1251份有效問卷,依26家醫院執行結果,一張處方合理調劑時間介於7分32秒與9分54秒,推估一位藥師每日調劑處方的合理上限值為64張,每小時調劑品項數不超過36項。依52家醫院問卷調查的結果顯示,現況以處方評估及用藥指導部分執行率最不佳,主要受限於人時不足。
結論:根據本研究的結果,臺灣的門診藥師人力尚不足夠,估算合理門診人力還需現行藥事門診人力之1.03~3倍。
英文摘要 Background
Under-staffed pharmacy and the lack of cognitive intervention from pharmacists have been suggested as reasons for the increased risks in dispensing interacting drugs and undetected medication errors.
Objective
To evaluate the optimal dispensing volume of pharmacist at outpatient department of hospitals in Taiwan.
Methods
Between September 2006 and June 2007, we conducted a field study in hospitals in Taiwan to evaluate the time required for hospital pharmacists to complete dispensing task in accord with the standard operating procedures (SOPs) developed by pharmacy experts. Linear regressions were used to estimate the required dispensing time and manpower, adjusting for characteristics of prescriptions, pharmacists, and hospitals. Pharmacists of the participating hospitals were also surveyed for their compliance to the SOPs during daily practice and the perceived barriers to comply with the SOPs.
Result
Twenty-six institutions had participated, which included medical centers, regional, and district hospital. A total of 1452 prescriptions were measured for the dispensing time, and 1290 questionnaires from pharmacists were collected. We employed the 90 percentile of dispensing time as the essential interval for complying with SOPs, which was found to be 7 minutes and 32 seconds to 9 minutes and 54 seconds. The maximum volume for a pharmacist to dispense in accord with the SOPs was 64 prescriptions per day. Among the SOPs, the compliance rates of prescription evaluation and consultation provision to patients were found to be lower than the other procedures, which could be attributed to the high workload.
Conclusion
The current dispensing load of pharmacist in the ambulatory care settings was significantly higher than the optimal volume. The implications on quality of pharmaceutical care need to be further explored.
論文目次 第一章 研究緣起 1
第二章 研究目的 3
第三章 文獻回顧 4
第一節、用藥安全 4
第二節、國內外相關藥事作業規範 8
2.2.1 世界各藥學組織之概況 8
2.6.2 國外組織對藥事調劑作業的相關建議 9
2.6.3 國內概況 11
第三節、調劑量與調劑疏失之相關性 13
第四節、醫療資訊科技與執行判斷性服務之相關性 15
第五節、藥師在病患諮詢服務之角色 18
第六節、藥事人力與病人安全之相關性 21
第四章 研究方法 24
第一節、研究設計 24
4.1.1 研究類型 24
4.1.2 研究時間與地點 24
4.1.3 研究對象 24
4.1.4 取樣標準 24
第二節、研究假說 25
第三節、研究架構 30
第四節、研究工具 30
4.4.1 標準操作程序之定義 30
4.4.2 調劑操作實測記錄表 33
4.4.2.1 記錄表內容 33
4.4.2.2 記錄表填寫格式 33
4.4.3 調劑作業程序現況調查問卷 33
4.4.3.1 問卷內容 33
4.4.3.2 專家效度 34
4.4.3.3 信度分析 35
第五節、研究變項及評估指標之定義 36
4.5.1 研究變項 36
4.5.1.1 標準操作程序實測變項 36
4.5.1.2 調劑作業現況調查問卷變項 40
4.5.2 評估指標 43
第六節、資料彙整與分析 44
4.6.1 統計分析軟體 44
4.6.2 統計分析方法 44
第五章 研究成果 48
第一節、標準操作程序之實測 48
5.1.1處方樣本統計量之描述 48
5.1.2醫院作業及設備系統變項統計量之描述 51
5.1.3合理調劑時間之描述 54
5.1.4影響調劑作業時間之預測因素 61
第二節、調劑作業現況調查問卷 75
5.2.1樣本統計量之描述 75
5.2.2標準操作程序執行率之描述 77
5.2.3影響標準操作程序執行之因素 84
第三節、合理門診藥事人力之估算 90
第六章 研究討論 93
第一節、資料品質 93
6.1.1實測處方 93
6.1.2 調劑作業現況調查問卷 94
6.1.3 實測與問卷結果之比較 94
第二節、合理調劑量上限值之比較 95
6.2.1 合理調劑時間之比較 95
6.2.2調劑量上限值之比較 97
第三節、醫院電子化規模與執行判斷性服務之相關性 99
第四節、磨粉分包業務對調劑作業之影響 101
第五節、病患對於用藥指導之需求 103
第六節、現況與實測結果之比較 105
第七章 研究限制與未來研究方向 108
第一節、研究限制 108
第二節、未來研究方向 109
第八章 結論與建議 110
參考文獻 112

表 目 錄
表2.1、各國藥事作業規範及主張與優良藥品調劑作業規範之相異點 12
表4.1、文獻建議的調劑步驟及彙整而得的標準作業程序之比較 31
表5.1、處方張數分布 48
表5.2、參與實測之藥師執業年資 48
表5.3、處方異質性 49
表5.4、處方異質性─依醫院層級分類 49
表5.5、病患異質性─依醫院層級分類 50
表5.6、處方資訊完整性─依醫院層級及權屬別分類 53
表5.7、自動化設備系統─依醫院層級及權屬別分類 53
表5.8、實測處方總調劑時間分佈─依處方性質分類 57
表5.9、總調劑時間之線性迴歸分析─實測處方變項 65
表5.10、處方評估之線性迴歸分析─實測處方變項 67
表5.11、藥品調配之線性迴歸分析─實測處方變項 69
表5.12、再次核對之線性迴歸分析─實測處方變項 71
表5.13、交付藥品之線性迴歸分析─實測處方變項 73
表5.14、用藥指導之線性迴歸分析─實測處方變項 74
表5.15、問卷樣本數分佈 76
表5.16、藥師基本資料 76
表5.17、藥師執業年資─按醫院層級區分 76
表5.18、藥師執業年資─按權屬別區分 76
表5.19、描述性統計分析─標準操作程序執行率 78
表5.20、描述性統計分析─限制執行因素 81
表5.21、處方評估之線性迴歸分析─問卷變項 85
表5.22、藥品調配之線性迴歸分析─問卷變項 86
表5.23、再次核對之線性迴歸分析─問卷變項 87
表5.24、交付藥品之線性迴歸分析─問卷變項 88
表5.25、用藥指導之線性迴歸分析─問卷變項 89
表6.1、各區處方樣本數與醫院家數比例之比較 93
表6.2、各步驟執行平均時間─依調劑量等級區分 107

圖 目 錄
圖2.1、門診照護之藥品使用流程圖 5
圖2.2、用藥疏失根原因分析魚骨圖 7
圖4.1、研究假說模型 29
圖4.2、研究架構 30
圖4.3、調劑操作實測記錄表統計分析流程圖 46
圖4.4、調劑作業現況實測問卷統計分析流程圖 47
圖5.1、處方分佈─依就醫科別分類 50
圖5.2、敏感性試驗─合理調劑時間理想值及下限值 54
圖5.3、總調劑時之比較─依處方性質分類 55
圖5.4、各步驟平均時間所占之比例─依處方性質分類 58
圖5.5、總調劑時間及處方張數分佈圖─依品項數分類 59
圖5.6、各步驟90%處方完成時間─依品項數分類 60
圖5.7、合理調劑時間散佈圖─理想值 91
圖5.8、合理調劑時間散佈圖─下限值 91
圖5.9、工作量壓力指標散佈圖─理想值 92
圖5.10、工作量壓力指標散佈圖─下限值 92
圖6.1、調劑量等級與調劑量時間之散佈圖─以各醫院實測結果換算 105

附 表 目 錄
附表2.1藥品優良調劑作業準則及優良藥品調劑作業規範條文對照表 122
附表4.1調劑實測記錄表 130
附表4.2 調劑作業程序現況調查問卷 132
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