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前言：判断性服务是指药师调剂时发现用药可能的疑义，与医师进一步联络讨论後，修正处方并重新调剂的过程。过去的研究发现药师判断性服务可以减少医疗资源浪费、提升用药安全性，以及开药的准确性。因此，卫生福利部与药师公会在台湾大力推广判断性服务到各级医疗单位。然而，目前仍没有很好的研究，去评估判断性服务在中药调剂的使用情形。本研究藉由分析区域教学医院的药剂科资料库，尝试了解判断性服务在中药调剂的应用现况。
方法：本文分析统计台北市立联合医院仁爱院区2011-2016 年之药剂科资料库，选取中药处方判断性服务之案例，并依照台北市立联合医院药剂部建立之AABBCC 编码表，分析药师所发现的疑似药物治疗问题（AA 码）、药师建议内容（BB 码）、以及医师的回应结果（CC 码）分项进行分析。统计各分项内问题出现的次数、频率、以及占整体发生个案的比率。
结果：自2011 年至2016 年5 月底，本研究共收集了97 个案例。分析药物治疗问题发现异常剂量最为常见，其中剂量太低占多数共44 例，剂量太高6 例。除此之外，常见错误包含给药方式不正确共21 例，以及重覆用药共12 例。药师介入则以建议改变剂量最多共50 例，其次为建议改变用药间隔25 例，以及建议暂时停用特定药物12 例。医师接受药师的判断性建议後，有47 例作出更改剂量的决定，另外有27例更改用药间隔，停用药物与更换另一种药物则较少。
结论：药师的判断性服务在中医领域仍刚起步，在药师的协助与建议下，可以帮助中医师减少可能的剂量、服法错误，增加用药安全性并减少意外失误。
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Su-Jhen Wu1 Shu-Chuan Wu1 Chao-Tsung Chen2 Shun-Ku Lin2*
1Department of Pharmacy, Taipei City Hospital, RenAi Branch, Department of Health, Taipei
City Government
2Department of Chinese Medicine, Taipei City Hospital, RenAi Branch . Department of
Health, Taipei City Government
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Background: Cognitive service is that pharmacists swap medication may be doubts, and physicians further contact discussion, modify the prescription and readjustment process. Previous studies have found that pharmacist-based cognitive services can reduce the waste of medical resources, improve drug safety, and prescribe the accuracy. Therefore, the Ministry of Health and Welfare and Pharmacists Association in Taiwan to promote cognitive services to all levels of medical units. However, there is still no real study to assess the use of cognitive services in the case of Chinese medicine swap. In this study, by analyzing the database of pharmacy department of the regional teaching hospital, we try to know the application of judgment service in Chinese medicine dispensing.
Methods: This study was to analyze the pharmacy department database of Taipei City Hospital from 2011 to 2016 and to select the case of prescription cognitive service. According to the AABBCC code table established by the Association of Chinese Pharmacists Association to analyze the suspected (AA code), pharmacist advice (BB code), and physician response (CC code). The frequency and frequency of occurrence of problems within each sub-item, and the ratio of the total number of cases.
Results: From 2011 to the end of May 2016, 97 cases were collected in this study.Analysis of drug treatment problems Abnormal dose is the most common, which accounted for 44% of the total dose is too low, the dose is too high in 6 cases.Also, the common types of errors include 21 cases of incorrect administration and 12 cases of repeated drug use. Pharmacists involved in the proposed changes in the dose of a total of 50 cases, followed by the proposed change in drug interval in 25 cases, and the suggested time to disable specific drugs in 12 cases. After the physician had accepted the pharmacist’s judgment, 47 had the decision to change the dose, and 27 had a change in medication interval, with fewer drugs and less.
Conclusions: The pharmacist’s cognitive service is still in the field of Chinese medicine. With the assistance and advice of the pharmacist, the Chinese medicine physician can reduce the possibility of taking wrong medication on dose, increase the safety of medicines and reduce the unexpected error.
Keywords： Traditional Chinese Medicine, Pharmacists’ Cognitive Service, Drug Safety
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202.2 药师判断性服务於中医领域实例分析
