運用資訊化給藥系統降低化學治療給藥異常成效之探討

An Information technology-assisted drug delivery system reduces administration errors in

chemotherapy湯梅芬、張明利、陳秀鉛、周寶鈺臺北醫學大學˙市立萬芳醫院

Mei-Fen Tang, RN1, Ming-Li Chang, RN1,2, Shoiou-Chian Chen, RN1, Pao-Yu Chou, RN1 1Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

2Department of Industrial Engineering, Chung-Yuan Christian University, Taipei, Taiwan

Chemotherapy medications are high risk medications. Administration errors usually cause serious harms to patients. Therefore ways to Chemotherapy provide medical personnel security chemotherapy drug delivery systems, and reduce the chemotherapy dosing errors become the hospitals to priority. In this study, we used Computerized Physician order entry (CPOE) and Barcoded medication administration (BCMA) systems to assist chemotherapy administration. The results showed that the two systems effectively reduce the number of errors in administration of chemotherapy from 6 events to 2 events. The near-miss rate of chemotherapy administration dropped from 2.06% to 1.08%.

Issues of patient safety are common concerns worldwide and an important indicator of quality of care. Medication safety is one of the top concerns. Xie et al (2009) study found that medication errors mainly include : (1) inconsistent prescription, (2) unclear abbreviations, (3) medical personnel are not familiar with the standard procedure, (4) lack of education and training, and (5) as incorrect transcription of the doctor's orders. O'Shea (1999) also pointed out that repeatedly prescribing process and inelligilore , prescription writing increase the chances of medication errors. Therefore, administration operations to accelerate the integration and construction of information technology to reduce human errors are important strategies to reduce medication error.Because chemotherapy treatment guidelines are more strict, and treatments are complex, chemotherapy agents are high-risk medications. Computerized Physician order entry (COPE) is an important patient safety measures (Chan J, 2011), more widely used in hospitals to prevent prescription errors and prevent drug errors (Koppel R, 2005). The Barcoded medication administration (BCMA) system for handheld scanners to read bar codes on patients and to identify drugs can help confirm the five "rights" of drug administration: right patient, drug, dose, way and time. Ross (2008) pointed out that the BCMA systems are commonly used in hospitals to prevent medication administration errors. Therefore, this study aimed to assess the implemental of COPE and the BCMA chemotherapy drug delivery systems in reducing errors in the administration of medication errors.

Abstract

Introduction

Materials and Methods

In addition, the compliance rate of physicians in implement the COPE was monitorial .In March 2010 by the nurse and jointly established the chemotherapy BCMA system. This system includes automatic control of chemotherapy drugs delivery from the dispensing room, chemotherapy drug delivery flow control, chemotherapy drugs sign out flow control, flow control of chemotherapy administration, treatment of chemotherapy administration. The IT nurse held several BCMA training course for nurses, pharmacists, and transport personal .Furthermore, the BCMA of compliance rate was monitorial as one of quality indicators.

Results1. chemotherapy for medicine exceptionally before the

project implementation, a totally 8 medication error per year in 2009. After the project implementation, only 2 events per year occur in 2011.

2. nurses to comply with the implementation of barcode systems administration degree from 80.55% in March 2011 raised to 98.87% in August.

3. for the implementation of chemotherapy administration of hospital nursing staff in three units of information technology operations of chemotherapy administration control satisfaction survey, a total of 35 questionnaires, the average satisfaction of 81%, of which fewer nurses due to a unit implementation of chemotherapy administration, are not familiar with the operating procedures, so satisfaction is low.

4. April-June 2009 compared with April to June 2010, the near-miss rate of chemotherapy administration dropped from 2.06% to 1.08%.

Discussion and ConclusionsThe results of this study show through chemotherapy administration operations of technology control (CPOE and BCMA chemotherapy drug delivery systems), can indeed reduce the occurrence of abnormalities related to chemotherapy administration.

In January 2010, oncologist, surgeons, and information technology (IT) staffs collaborated on a project to COPE system for chemotherapy prescription orders .This system consists of chemotherapy orders, order sheet and administrated sheet print out. IT staffs need several education and training courses to promote CPOE operation.

Key words： Barcoded medication administration (BCMA) systems , Administration errors in chemotherapy

護理人員化療治療結束

護理人員進行化療給藥

結 束

護理人員點收化療藥品

傳送人員至藥局領取化療藥品

藥師調配化療藥品並出庫

給 藥簽 收傳 送出 庫

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