提升內科病人自備藥物管理改善專案

Prevent duplicate medication and improve drug safety for patients are two critical issues of patient safety in the recent years, as well as the 2016 Annual Patient Safety Goal released by the Ministry of Health and Welfare. The hospital policy requires patients to hand over their chronic medication (Patient's Own Medication, POM) to the nursing unit upon admission. However, it was identified that in clinical nursing, the POMs were not returned upon patients' discharge, resulting in patient medication issues. According to the 2015 census, the rate of POMs not returned to the patients were as high as 13.8%, which resulted in the planning of this project. The aim of this project was to prevent duplicated medication and improve drug safety. After literary review and incident investigation, the following problems were identified: inadequate cognition and incorrect handling of POM, no SOP for POM during shift change, inappropriate POM storage, and lack of routine internal audit. The project included the following improvements: establishing a SOP for POM during shift change, initiating on-job training program, cooperating with the information office in developing an order entry system for POM, purchasing dry cabinets for POM storage and engraving seals for POM labeling and management. With the implementation of these interventions, we expect to see improvements in the handling and storage of POM in the future.