第五章 討論
第五節 未來研究方向
此研究為一回溯性之研究，對於國內藥師參與醫療團隊提供藥 事服務，在經濟效益上的研究進行初步之探討，若醫院管理者能提 供足夠的藥師人力，配合前瞻性的研究方法，就藥師進駐一般病房 或加護病房提供藥事照顧，執行較長時間之效益研究，將可以獲得 更詳盡的資料，提供兼具品質、病患滿意及經濟效益的醫療服務，
也為國內醫療照顧開啟醫院及患者雙贏的新局面。
第六章 結 論
93 年間藥師提供每週 4 小時的病房內照護，佔週工作時數的 9.5%，以藥師平均薪資每月 50,000 元計算，依花費時間換算成其支 付的薪資每月個為 4,750 元，而在 94 年間藥師提供每週 20 小時的病 房內照護，佔週工作時數的 47.6%，同樣依花費時間來換算則每個 月需支付的薪資為 23,800 元，兩組間每個月支付薪資的差異為 19,050 元。
兩組間每日 ICU 藥費降低 894 元，而平均加護病房入住天數降 低 0.67 天。依此結果顯示，藥物費用在病房 80% 佔床率的前提下，
每個月節省的費用為 472,032 元，而在入住天數縮短方面，以每月 平均收住 70 名病患計算，可節省病房費用達 459,620 元，合計共節 省 931,652 元之醫療花費。若將節省之費用與因增加藥事照護時數 所增加的藥師薪資相除，可得到其效益/費用比率為 48.9：1。若進 一步探討加護病房佔床率為滿床的狀況時，則將因減少入住天數，
增加每月收住病患，其經濟效果將更加的顯著。
經由分析醫療資源耗用的相關因素，以及 93 年和 94 年間醫療 費用差異的結果可以得知，藥師提供入住加護病房患者藥事服務，
其參與重症照護的時間，足以影響醫療照護的費用。
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附錄一 個案醫院臨床藥師之職責
一、接受醫師之處方箋，複查處方中有關藥品劑量、用法、給藥時 間是否正確，有無交互作用及配伍禁忌。
二、依據住院藥局電腦功能及至病房訪視病患，就醫護人員、患者 暨家屬所述及病歷中記載，知道病人用藥史、是否有藥物過敏 史等作成書面紀錄。
三、提供醫師、護士、呼吸治療師、營養師… 等查房團隊成員，有 關的臨床藥學和藥物諮詢服務。
四、參與查房團隊，充份瞭解醫師敘述及病歷記載有關病程、治療 及照護計劃，提供藥物諮詢服務或提出用藥建議，並作成書面 記錄。
五、利用藥物動力學原理，提供藥物血中濃度監測(TDM)建議，並根 據測出之藥物血中濃度、病情、腎臟功能狀況，建議醫師調整 藥物投與量或間隔。
六、提供健保局用藥規範、藥品價格等資訊，作為建議醫師改變治 療處方之依據。抗生素使用是否照會感染科醫師，使用期限及 使用劑量是否合理。
七、協助醫師瞭解病患使用 TPN solution，由 TPN 調配藥師負責調
八、針對病患治療之需求，協助醫師瞭解病患有關點滴輸液與電解 質使用的情形。
九、提供護理人員之用藥教學、正確給藥及抽血時間的基本概念。
十、藥物不良反應通報(ADR reporting)
1. 從參與查房及病患用藥訪視中發現藥物不良反應的可能案例。
2. 提醒醫護人員對於治療個案發生藥物不良反應的警覺性。
3. 鼓勵及協助醫護人員通報疑似藥物不良反應案例及協助評估。
十一、針對病房使用藥物，選定評估藥品→訂定評估標準→收集數 據→分析結果→ 作為提升用藥品質之依據→ 持續性追蹤→
定期分析結果。
十二、整理及提供有關藥物配伍、貯存及安定性資料表，當作病房 用藥之參考。
Î 就用藥適當性之審核原則：
1. 選藥之適當性。
2. 用藥之劑量、給藥間隔正確。
3. 治療療程正確性。
4. 避免重覆使用同類藥物及使用藥物種類是否合理。
5. 藥物過敏之記載。
6. 抗生素使用是否合理。
7. 依據各加護病房用藥品項評估使用是否合理。
8. 用藥安全評估及監測。