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標題: | 化學治療藥物給藥流程中錯誤因素的質性探討
-以某醫學中心為例 A qualitative study on medication errors in process for providing chemotherapy:An example of a medical center |
作者: | Chiu-Feng Su 蘇秋鳳 |
指導教授: | 鍾國彪 |
關鍵字: | 化學治療藥物,處方錯誤,調配錯誤,给,藥錯誤,安全防護機制, chemotherapy agent,prescription error,dispensing error,administration error,safety protection, |
出版年 : | 2006 |
學位: | 碩士 |
摘要: | 化學治療藥物,若是用藥過程中因不適當的處方、調配錯誤或給藥錯誤,產生用藥錯誤的醫療疏失,例如不適當的劑量過高,可能會破壞病患的治療結果,或是產生主要器官衰竭甚至於死亡。在執行高危險的化學治療藥物給藥過程中,不管是在醫師開立處方、轉錄處方,藥師進行藥品調配,或是護理師執行化學治療藥物與點滴輸液投與過程中,都可能造成錯誤。因此本研究的目的是,針對不同專業的醫療人員,及病患與家屬,提供化學治療藥物給藥流程中錯誤的經驗與看法,並探討影響化學治療藥物給藥流程錯誤的因素。研究設計是以質性深度訪談的方式,對象是有實際執行化學藥物治療,包括開處方的醫師四人(兒科二人、血液内科二人)、調配藥物的藥師八人、與執行給藥的護理人員十人(兒科6人、血液內科兩人),以及監控治療的病童家長三人,進行深度訪談。檢視流程中現有的安全防護機制與造成給藥錯誤的原因。研究結果發現,
(一)醫師錯誤的因素:小兒血液科醫師錯誤的原因,以個人疏失、不小心居多,成人血液科以系統因素比較高,包括核對未確實、未使用標準化的療程計畫書、由對處方陌生的住院醫師開立、欠缺一致性標準化的格式、手抄醫囑字跡潦草、口述處方醫囑。 (二)藥師錯誤的因素:針對藥師調配錯誤的部分,主要是系統因素,以核對處方未確實居多,其次是手工作業流程太多,處方量負荷量大與時間的急迫性為主。 (三)護理人員錯誤的因素:護理人員錯誤的原因,小兒科的病房,以個人疏失居多,包括沒有覆核藥品、沒有覆核點滴。成人血液科的病房的錯誤因素,屬於系統因素居多,包括醫囑沒有書寫清楚、醫師態度輕忽、安全防護機制失靈。 (四)對於系統中各個不同流程中的防護機制:認為覆核的流程不能少,標準療程計畫書要設立、流程簡化、減少轉錄的過程等。給藥流程中屬於監督角色的病患,獲取醫療相關資訊的方式,有醫療人員主動提供,以及病患與家屬的主動學習。 依據以上結果,提出幾點建議: (一)機構應設立與匯整標準化的療程計畫書,並且訂定使用的標準化格式。 (二)化學藥物治療的病房應集中與整合,護理人員的訓練更精簡有效率。 (三)病患收住院作化學治療的規範要更明確與確實執行,讓給藥流程中的每一個單位有充裕的時間作業。 (四)對於藥劑單位主要的建議是,人員輪調不宜太頻繁,減少手工作業的部分。 (五)對血液科的醫師建議醫囑與處方應清楚的填寫。對藥劑同仁與護理同仁,給藥流程中的覆核已經非常的完備,需要加強的是確實執行的程度。 (六)對未來研究者的建議:建議未來的研究者針對這個主題,可以嘗試將樣本數擴大至全部的醫學中心及區域級以上的醫院,採取問卷調查與焦點團體同時運用的方法,可以兼顧資料的廣度與深度。 關鍵字:化學治療藥物、處方錯誤、調配錯誤、给藥錯誤、安全防護機制 If there is inappropriate prescription, dispensing mistake or administration error in chemotherapy process, for example inappropriate high dose chemotherapy agent, it may spoil therapeutic outcome and result in main organ failure even death. In the process of high- risk chemotherapy agent administration, error may happen in any medication-use process, including physician prescription and transcription, pharmacist dispensing, and nurse administration, fluid supplement. The goal of this study is to find the experience and viewpoint the factors of medication errors in chemotherapy agent administration process. This is a qualitative study for personal interviews with relevant medical staff. The medical staffs include four physicians (two pediatric physicians, two hematologists), eight pharmacists, ten nurses (six in pediatric ward, two in hematology ward) and three patient families. We investigate safety protection mechanism and medication errors in medication-use process for chemotherapy. The study findings are: (1) Physician errors: pediatric physician has more personal errors including uncertain recheck; hematologist has more systemic errors including non-standardized protocol, unfamiliar resident prescription, and lack of standardized format, scratchy handwriting and oral prescription. (2) Pharmacist errors: most of pharmacist errors are systemic errors, uncertain recheck is the most common error, other errors include too may handwriting procedures, heavy prescription loading and time strain. (3) Nurse errors: in pediatric wad, personal error is main. Errors including uncertain medication and fluid recheck. In hematological ward, most errors belong to systemic factors, including unclear prescription writing, careless attitude, and failure of safety protection mechanism. (4) The safeguards in various medication-use processes in system: recheck is necessary, standardized therapeutic protocol, simplified procedure, and reduction of transcription should be set up. Patient and family suggest medical staff should actively supply relevant medical information, and they themselves should learn knowledge voluntarily. According to above findings, we have some suggestions: (1) Our suggestion to hematologist is the order and prescription should be clear, and suggestion to pharmacy and nurse staff is to enforce the actual execution though recheck is certain. (2) Our suggestion to pharmacy department is to reduce staff redeployment and handwriting work. (3) Organization should set up and accumulate standardized chemotherapy protocol, and order standardized format Chemotherapy treatment ward should be assembled and integrated, and nurse staff training will be more concise and effective (4) In order to give each department in treatment enough time, the rule of inward patient chemotherapy should be clearly and certainly executed. (5) Our suggestion to future researcher is to enlarge the study targets to all medical centers and district hospitals, to combine qualitative and focus group interviews to cover both data depth and width. Key words: chemotherapy agent, prescription error, dispensing error, administration error, safety protection |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/31584 |
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