| Summary: | 碩士 === 高雄醫學大學 === 藥學系碩士在職專班 === 106 === According to statistics of the Ministry of the Interior, Taiwan officially entered the “aged society” in March 2018, with the elderly/total population ratio of 14.05%, and Aging Index (elderly/children population*100%) reaching 107.4. Numer of long-term care institutions increased from 1,067 in 2015 to 1,100 in 2017, with the accommodated elderly/disabled elderly requiring long-term care reaching 27.98%. Medication use by admitted residents were complex and with varieties, but there is little emphasis on medication use safty management at present. Despite the emphasis on drug regimen review, the discussion of policy and procedure on safe medication use process and management by the institutions remain scarce. Therefore, this study adopted the “Assessment tool on the quality of medication safety and management in Long-term Care Facilities” established by Taiwan Pharmacist Association for the pharmaceutical services in long-term care institutions. After carrying out the reliability and validity tests on the assessment tool, two institutions were evaluated. Recommendations were provided after each assessment to exhort improvement. After three assessment sessions, differences before and after the intervention of pharmacists were compared.
The expert validity of the assessment tool reached 0.99. As for the consistency reliability after revising the scoring method and adding scoring criteria, the CVI value increased from 0.625 to 0.890, indicating high reliability. After the pharmacist interventions, Institution 1 improved by 9.87%, p=0.008 and Institution 2 improved by 32%, p=0.003, indicating high significance of changes. The results showed that the pharmacist recommendations based on the assessment tool and the support and cooperation of the institutions’ medical teams effectively improved the quality of medication use process and management in the institutions. The study amended the scoring method of the assessment tool to increase its accuracy. Also, the assessment tool truly reflects the actual situations of the quality of medication use and management in long-term care institutions, which is considered a sound measurement tool for continuous quality improvement.
This study further proposed a revised version of the assessment tool based on expert opinions, actual assessment findings, and existing long-term care institution accreditation criteria. The 2 aspects, 18 dimensions, and 58 assessment questions were changed into 3 aspects, 18 dimensions, and 65 questions, in the hopes of providing a more comprehensive assessment to help pharmacists promptly and completely examine the medication use process and management situations in the institutions. Finally, this study, with references to accrediatation methods used in the United States to evaluate pharmacists performance, suggested an “Assessment form for the quality of pharmacist services in Long-Term Care Facilities”, which shall serve as a reference for pharmacists in institutions to carry out the quality assessments of pharmacy professional services in the future.
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