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磨粉分包作業之品質及小兒用藥指導之成效探討磨粉分包作業之品質及小兒用藥指導之成效探討 • 研究背景在長期缺乏適合兒童服用之藥品下，各醫療院所已經習慣將成人服用之藥丸磨粉分包給兒童服用。但有許多主客觀的因素會影響磨粉分包的品質。過去由台大及成大醫院的研究結果均顯示：藥師臨場調製分包作業的品質並不理想。磨粉分包不但不符合優良藥品調劑作業規範，對病患更是有潛在的危險存在。實有必要進行研究以建立小兒家長正確的兒童用藥觀念因而選擇正確的用藥。研究目的1. 探討藥師、醫師及護理人員執行磨粉分包作業之品質；藥師人員及非藥師人員在作業品質上是否具差異性，以探討人為因素對品質之影響。2. 經由藥師對病童家長的用藥指導之後，能否改變其舊有的用藥觀念。期使照顧病童的家長們在日後能有正確的用藥知識、態度並提昇用藥安全性及有效性。研究方法ㄧ、磨粉分包作業及重量測試四組醫療人員（資深藥師、新進藥師、護理人員、醫師）分別進行五種處方之磨粉分包作業，之後由單一研究者進行各分包之重量差異試驗，計算重量分佈相對標準差，最後進行統計分析，以探討各種處方、各組醫療人員對重量分佈相對標準差之影響。二、問卷調查及兒童用藥教育在問卷發展測試完後，將合格之家長納入本研究，先填寫用藥教育前問卷調查(包拓實際用藥情形調查、態度問卷、知識問卷)，次日即對家長進行兒童用藥教育，本研究一對一的教學方式。在教學並與家長討論問題完後，即要求家長填寫用藥教育後問卷調查(包拓態度問卷、知識問卷、基本資料)，最後進行統計分析，以評估教育前後家長的用藥態度及認知程度之差異。研究結果一、磨粉分包作業品質之探討五種處方之磨粉分包其重量分佈相對標準差（WCV%）介於4.52%至51.49%之間且有分包之平均重量越大、差異越小之趨勢。藥師人員在執行磨粉分包作業時所造成的重量差異都比醫師及護理人員小，其中還有三種處方具統計上有意義之差異。但就重量差異整體而言，磨粉分包的確不是理想的給藥方式。二、兒童用藥教育之成效探討用藥態度：服用藥水之態度於教育前已很正向，所以教育後進步並不大。教育後，服用藥粉之態度及總和態度均達到統計學上顯著之改變。用藥知識：教育後，各個次分類及總和分數均達到統計學上顯著提升。顯示透過本教育方式，確實能夠有效改變、提升家長的用藥態度及知識。研究結論本研究再次證實成大醫院及台大醫院之研究結果：磨粉分包不是一種理想的給藥方式，因為會造成實際重量差異與理論值有極大的差距。本研究更進一步證實小兒家長其舊有的用藥觀念是可以藉由藥師用藥教育的介入而有所改變。期望用藥觀念的改變能更進一步影響到小兒家長的行為 ，因而選擇正確的用藥、增進小兒服藥順從性，以保障小兒藥物治療之安全與有效。
Study on Quality of Divided Powders and Impact of Education Program on Pediatric Drug Formulations • PurposeThe purpose of the study was to evaluate：1. The weight variation of five pediatric prescriptions in divided powders dosage form.2. The effectiveness of an education intervention on attitudes and knowledge regarding pediatric drug formulations.Methods1. Five pediatric prescriptions in divided powders dosage form were prepared by pharmacists, nurses and physicians respectively. Weight variation analysis was performed for the preparations, and the coefficients of variation of weight（WCV%）were calculated accordingly as the outcome measurement.2. Parents of pediatric patients at the inpatient department of Taipei Municipal Wang-Fang Hospital (TMWFH) were enrolled. An education program was conducted individually. Questionnaires containing attitude and knowledge measurements were completed by the parents before and after the education program. Patient's preference to the usage of pediatric formulations was analyzed before the education program.Results1. The WCV% calculated from all of the divided powders ranged from 4.52% to 51.49%, with a tendency for larger mean weight to have less WCV%. All the mean WCV% of pharmacists was less than that of nurses and physicians.2. One hundred and two parents of pediatric patients were recruited from March 2002 to April 2002 in TMWFH. After the education program, the attitude scores were significantly improved in the subscale of divided powders and the total scale. The total knowledge scale was significantly increased from 4 to 9 and all the subscale scores were significantly increased (p < 0.05) after the education program.ConclusionThis study demonstrates that the divided powders can have considerable problems on dosage uniformity, and the education program provided by the pharmacist is able to cause attitude and knowledge change. This attitude and knowledge change can provide further insight into behavioral change.
