郭青萍KUO, CHING-PYNG陳季姍CHEN, JI-SHANJI-SHANCHEN護理學系碩士班2026-10-282030-01-2220252025-01-17https://handle.ncl.edu.tw/11296/f2jzwjhttps://scholars.csmu.edu.tw/handle/123456789/34764背景與目的：長照機構病人出院後的轉銜被視為藥物不良事件（ADE）的高風險時期，而轉銜護理交接是確保病人用藥安全的重要環節，不當的轉銜交接可能導致再住院風險增加。因此本研究使用8P再住院風險評估概念，著重於高風險用藥安全，從識別（Identify）、減緩（Mitigate）到溝通（Communicate）的設計，以探討出院轉銜用藥安全核對清單對長照機構住民14天內發生再住院之影響。研究方法：採類實驗設計於中部某區域教學醫院內科病房自113年3月7日至11月4日共完成實驗組與對照組各100人之收案。以美國醫院整合醫學學會發表之Project Boost® imPlementation guide中提出之8P screening Tool 風險評估概念，所建立之轉銜用藥安全核對清單，作為實驗組的介入措施，對照組則維持常規護理。所得資料以SPSS 22.0版進行統計分析，探討介入措施對長照機構住民14天內發生再住院的影響。研究結果：本研究納入的長照機構住民平均年齡為76.1（±13.1）歲，年齡範圍介於21至98歲，女性（52%）略多於男性（48%）。健康問題以高血壓最為常見（67%），其次為糖尿病（35.5%）及中風（33%）。住院診斷以肺炎佔比最高（36.5%），其次為泌尿道感染（32.5%）。平均使用約7種藥物，其中以鎮靜安眠藥為最常使用的高風險用藥（42.5%）。護理師平均年齡為30.8（±7.4）歲，均為女性，學歷以大學為主（71.4%），年資主要集中於2至5年（55.6%）。護理師對高風險用藥的認知平均分數為50.7（±17.6）分，分數集中於40至70分之間（64.3%）。分析發現，長照型機構住民的再住院比例顯著高於護理之家住民（p=.009）；而14天內再住院與未再住院住民的過去病史並無顯著差異（p=.130~.824）；但在再住院組住院診斷為泌尿道感染的比例顯著低於未再住院組（17.6% Vs. 35.5%，p=.042）。實驗組的再住院風險為對照組的33.9%，即降低了66.1%（HR=.339，95% CI=0.158-0.726）的再住院風險。結論：運用轉銜用藥安全核對清單能有效減少長期照護機構住民14天內發生再住院的發生。本研究之轉銜用藥安全核對清單不僅具有風險識別功能，還包含具體的介入措施，從減少高風險用藥的使用及優化用藥交班流程，提供了一種整合風險評估與實際介入的創新模式，此模式不僅可提升用藥安全，亦可減少再住院之發生。Background and Objectives: The transition of care for patients discharged from long-term care facilities is considered a high-risk period for adverse drug events (ADEs). Effective transitional care handoffs are crucial to ensuring medication safety. Inadequate transitions can increase the risk of rehospitalization. This study adopts the 8P screening tool for rehospitalization risk assessment, focusing on high-risk medication safety. It incorporates a design emphasizing identification, mitigation, and communication to explore the impact of a Medication Safety Checklist at Discharge on 14-day rehospitalization rates among long-term care facility residents. Methods:A quasi-experimental design was conducted in a medical ward of a regional teaching hospital in central Taiwan from March 7 to November 4, 2024, enrolling 100 patients each in the experimental and control groups. The experimental group received an intervention based on a Medication Safety Checklist at Discharge developed using the 8P screening tool from the Project BOOST® Implementation Guide by the Society of Hospital Medicine. The control group received standard care. Data were analyzed using SPSS version 22.0 to evaluate the effect of the intervention on 14-day rehospitalization rates among long-term care facility residents. Results:The average age of the included long-term care facility residents was 76.1 (±13.1) years, ranging from 21 to 98 years, with slightly more females (52%) than males (48%). The most common health conditions were hypertension (67%), diabetes (35.5%), and stroke (33%). Pneumonia was the leading diagnosis for hospitalization (36.5%), followed by urinary tract infections (32.5%). On average, residents used approximately seven medications, with sedative-hypnotics being the most frequently used high-risk medication (42.5%). Nurses’ average age was 30.8 (±7.4) years, all female, predominantly with a university education (71.4%), and most had 2–5 years of experience (55.6%). Nurses’ average knowledge score on high-risk medications was 50.7 (±17.6), with scores ranging from 40 to 70 (64.3%). Analysis revealed that long-term care facility residents had a significantly higher rehospitalization rate than nursing home residents (p = .009). No significant differences were found in past medical history between the 14-day rehospitalization group and the non-rehospitalization group (p = .130–.824). However, the proportion of urinary tract infections as a hospital diagnosis was significantly lower in the rehospitalization group compared to the non-rehospitalization group (17.6% vs. 35.5%, p = .042). The experimental group’s rehospitalization risk was 33.9% of the control group, representing a 66.1% reduction in rehospitalization risk (HR = .339, 95% CI = .158–.726). Conclusions:The Medication Safety Checklist for Discharge can effectively reduce 14-day rehospitalizations among long-term care facility residents. The checklist not only has the function of risk identification but also includes specific intervention measures, from reducing the use of high-risk drugs to optimizing the medication shift process, providing an innovative model that integrates risk assessment and practical intervention, which can not only improve drug safety but also reduce the occurrence of rehospitalization.出院轉銜用藥安全核對清單風險評估長期照護機構住民再住院Medication Safety Checklist at DischargeRisk AssessmentLong-Term Care Facility ResidentsRehospitalizationthesis