疑义处方探讨.pdf

疑義處方探討講員：石曉貞藥師疑義處方探討?處方之內容?住院處方評估?問題處方處理處方內容處方完整性?完整處方應具備 病人相關資料 疾病診斷 就醫科別/日期 藥品相關資料 處方醫師蓋章病人相關資料?性別?年齡(出生年月日)?種族?身高?體重 ?資料不正確的影響…. ?如何正確取得資料….藥品相關資料?藥品名稱、劑量、劑型?藥品服用劑量、途徑、用法?處方日期(起日-訖日)特殊藥物處方?感染管制用藥專用處方?1-3級管制藥品專用處方?全靜脈營養處方?化療藥品專用處方須考慮使用相關規範問題處方介紹問題處方?形式?輸入錯誤?處方內容錯誤MEDICATION ERRORS!輸入錯誤?輸入者取得資訊錯誤?例如：輸入醫師之手寫處方時，誤將A藥名當作 B藥名，輸入錯誤藥品輸入者操作錯誤?例如：操作電腦時點選品項錯誤常發生在同藥名不同劑量或同藥名不同劑型 時哪裡有問題?Rx: DIOVAN FC TAB 160MG IMURAN TAB 50MG NORVASC TAB 5MG LASIX TAB 40MG LIPITOR FC TAB 40MG * 診斷：HCVD、HYPERLIPIDEMIA 正確應為：IMDUR 60MG 造成的影響：心臟症狀未獲控制、免疫力下降造成輸入錯誤常見原因?手寫處方-將手寫醫令輸入電腦?人員訓練不足?人員疏忽?系統選項無特別辨識方式Table 1. Commonly Misinterpreted Medical Abbreviations AbbreviationIntended Meaning Possible Misinterpretation U Units Mistaken as a zero or a four (4) resulting in overdose. mg Micrograms Mistaken for “mg“ resulting in a 1,000-fold overdose. QD Every day The period after the “Q“ has sometimes been mistaken for an “I,“ and the drug has been given QID rather than daily. QOD Every other day Misinterpreted as “QD“ or “QID.“ If the “O“ is poorly written, it looks like a period or an “I.“ SC or SQ Subcutaneous Mistaken as “SL“ (sublingual) when poorly written. TIW Three times a week Misinterpreted as “three times a day“ or “twice a week.“ D/C Discharge; also discontinue Patients' medications have been prematurely discontinued when “D/C“ was intended to mean “discharge“ versus “discontinue.“ HS Half strength Misinterpreted as the abbreviation “HS“ (hour of sleep). cc Cubic centimeters Mistaken as “U“ (units) when poorly written. AU, AS, AD Both ears; left ear; right ear Misinterpreted as the abbreviation “OU“ (both eyes); “OS“ (left eye); “OD“ (right eye). A Systematic Approach to Preventing Medication Errors/ U.S. Pharmacist本院音似品項表(節錄)項次藥品名稱單位ADALAT 10MG CAP CAP ADALAT OROS 30MG TAB TAB ALCOS-ANAL SUPP PILL ALCOS-ANAL OINT 100GM/ 20GM TUBE ASACOL 500MG SUPP. TUBE AMARYL TAB 2MGTAB ANTAGEL TABTAB ARIMIDEX TAB 1MGTAB ANXIEDIN TAB 1MGTAB AMINOPHYLLIN TAB 100MGTAB AMOXICILLIN GRANULE 25MG/ML 60MLTAB ARTEOPTIC OPH SOLU 1% 5MLBOT ARTELAC EYE DROP 0.32% 10ML BOT ASACOL TAB 400MG TAB ASACOL 500MG SUPP. TAB ASACOL 2.0GM 100ML ENEMA BOT BAMBEC TAB 10MG TAB BLASEC TAB 2.5MGTAB BEROTEC 2.5MG TAB TAB BEROTEC UDV 1.25MG/2MLVIAL BRICANYL FOR NEBULIZING 5MG/2MLVIAL BEFON 5MG TAB (BACLOFEN) TAB BENZHEXOL TAB 2MG (B.H.L.) TAB BUSRON TAB 10MGTAB UROSIN FC 100MGTAB CAFERGOT TAB 1MG/100MGTAB CALTAGON ENTERIC FC TAB 50IUTAB CEFLEXIN CAP 500MG CAP CELEBREX CAP 200MG CAP CELANCE 250MCG TAB TAB CELANCE 0.05MG TAB CAP CIPROXIN FC TAB 250MGTAB CIPROXIN INF SOLN 2MG/ML 100MLBOT CLARINASE TAB 5MG/120MGTAB CLARITYNE TAB 10MGTAB CLARITYNE SYR 1MG/ML 60MLBOT CLINCIN INJ 150 MG/ML 2 MLAMP CILININ INJ 50MG/ML 2ML(VIT C)AMP CLOZARIL 100MG TAB TAB CLOZARIL 25MG TAB TAB 21491112101563478161315處方內容錯誤?藥物錯誤?劑量錯誤?劑型錯誤?途徑錯誤?病人錯誤藥物錯誤?輸入音似藥名?同藥名不同劑型/劑量?Ex : DOXABEN 2mg/tab V.S. DOXABEN XL 4mg/tab?Ex：CONCOR 1.25MG/TAB V.S. CONCOR 5MG/TAB?可能造成的影響：?給予過高劑量造成副作用增加或毒性反應?給予劑量不足造成療效不佳與藥物浪費?改善方式：?熟知藥局內之形似音似藥物品項?系統設定特別註記?提供醫護人員相關資訊?系統極量警示或鎖控本院音似品項表(節錄)項次藥品名稱單位ADALAT 10MG CAP CAP ADALAT OROS 30MG TAB TAB ALCOS-ANAL SUPP PILL ALCOS-ANAL OINT 100GM/ 20GM TUBE ASACOL 500MG SUPP. TUBE AMARYL TAB 2MGTAB ANTAGEL TABTAB ARIMIDEX TAB 1MGTAB ANXIEDIN TAB 1MGTAB AMINOPHYLLIN TAB 100MGTAB AMOXICILLIN GRANULE 25MG/ML 60MLTAB ARTEOPTIC OPH SOLU 1% 5MLBOT ARTELAC EYE DROP 0.32% 10ML BOT ASACOL TAB 400MG TAB ASACOL 500MG SUPP. TAB ASACOL 2.0GM 100ML ENEMA BOT BAMBEC TAB 10MG TAB BLASEC TAB 2.5MGTAB BEROTEC 2.5MG TAB TAB BEROTEC UDV 1.25MG/2MLVIAL BRICANYL FOR NEBULIZING 5MG/2MLVIAL BEFON 5MG TAB (BACLOFEN) TAB BENZHEXOL TAB 2MG (B.H.L.) TAB BUSRON TAB 10MGTAB UROSIN FC 100MGTAB CAFERGOT TAB 1MG/100MGTAB CALTAGON ENTERIC FC TAB 50IUTAB CEFLEXIN CAP 500MG CAP CELEBREX CAP 200MG CAP CELANCE 250MCG TAB TAB CELANCE 0.05MG TAB CAP CIPROXIN FC TAB 250MGTAB CIPROXIN INF SOLN 2MG/ML 100MLBOT CLARINASE TAB 5MG/120MGTAB CLARITYNE TAB 10MGTAB CLARITYNE SYR 1MG/ML 60MLBOT CLINCIN INJ 150 MG/ML 2 MLAMP CILININ INJ 50MG/ML 2ML(VIT C)AMP CLOZARIL 100MG TAB TAB CLOZARIL 25MG TAB TAB 21491112101563478161315藥物錯誤??藥物選擇適當性?病人個別化評估?肝、腎功能?藥物過敏史?年齡、性別、懷孕、哺乳…?禁忌症?重複用藥?交互作用病人個別化評估?除了依照藥物治療學選擇藥物以外，尚需 依照病人個別情況來考量醫師處方是否適 當：?肝、腎功能?藥物過敏史(入院用藥訪視)?年齡、性別、懷孕、哺乳…肝、腎功能評估?肝功能：?常用檢驗數據?AST(GOT) –細胞破壞?ALT(GPT) –細胞破壞?r-GT -酒精性肝炎/膽道阻塞?AFP –肝癌?ALBUMIN –製造機能?APTT、PT。