tag:blogger.com,1999:blog-80036063063636394822024-03-14T02:17:27.965-07:00台灣藥師參訪美國醫院藥事服務這是一位台灣藥師受派任參訪美國Kaiser醫院之手扎,記載生活點滴,參訪經驗分享,希望能提供更多經驗給有興趣的人分享....
Lin, Yung-Shunyslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.comBlogger16125tag:blogger.com,1999:blog-8003606306363639482.post-55934066387630916842010-03-03T18:10:00.000-08:002010-03-03T18:11:32.963-08:00旅遊相片(1)<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_XzpdLWvupYg/S48VL7DwVfI/AAAAAAAAAXQ/EgfRuxfZhaQ/s1600-h/Beverly+Hills1.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" kt="true" src="http://1.bp.blogspot.com/_XzpdLWvupYg/S48VL7DwVfI/AAAAAAAAAXQ/EgfRuxfZhaQ/s320/Beverly+Hills1.jpg" /></a></div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/_XzpdLWvupYg/S48VSJGRf6I/AAAAAAAAAXY/6L2DyinByLE/s1600-h/Beverly+Hills+%E5%95%86%E5%BA%97%E8%A1%971.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" kt="true" src="http://3.bp.blogspot.com/_XzpdLWvupYg/S48VSJGRf6I/AAAAAAAAAXY/6L2DyinByLE/s320/Beverly+Hills+%E5%95%86%E5%BA%97%E8%A1%971.jpg" width="320" /></a></div><br />
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</div>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com0tag:blogger.com,1999:blog-8003606306363639482.post-72662406567454667522010-02-28T20:08:00.000-08:002010-03-03T18:00:26.435-08:00參訪Kaiser Permanente另一院區(Roseville)2010年2月25週四,在 Inpatient Pharmacy Director安排下參訪 Kaiser Permanente Roseville Medical Center,發現該院區不僅在作業環境,或對病房硬體設備上有許多貼心設計,提供讀者參考:<br />
<div class="separator" style="clear: both; text-align: center;"></div>首先:由於該院區占地廣,主要分為五大區域,(A,B,C,D,E).也見到連接兩棟建築間空橋<br />
因此,除了在院區各建築主要入口處位置標示圖外,也可見整體書面位置簡圖供訪客取閱.<br />
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連接兩棟建築空橋<br />
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潔淨寬敞候診區<br />
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兒科化療室貼心設計<br />
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</div><div class="separator" style="clear: both; text-align: left;">Inpatient Pharmacy內設備環境</div><div class="separator" style="clear: both; text-align: left;"><br />
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</div><div align="left" style="text-align: left;">此處冰箱為兩面門</div><div align="left" style="text-align: left;">(優點是放入與取出不同,可先進先出,另外可管控針劑調劑區不必要進出)<br />
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</div>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com1tag:blogger.com,1999:blog-8003606306363639482.post-67397943943505753652010-02-06T20:26:00.000-08:002010-02-06T22:03:22.902-08:002010年大Sacramento區華人新春聯歡會再過幾天就是華人農曆新年,在海外華人也非常重視這個屬於華人的重要節日.<br />
在 KP Inpatient Pharmacy Director : Sxxx的邀約下,我有此榮幸參與 大Sacramento地區第十 三屆華人新春年歡會活動,本次活動在2010 年 2 月 6 日假 加州 Sacramento 州立大學舉行,由來自大Sacramento 地區許多華人組織,機構提供表演活動,共同慶祝 2010 年虎年到來.<br />
來自台灣同鄉會表演活動 : 藉由放映介紹台灣影片搭配台灣歌曲台北的天空,梨花痴情淚,綠島小夜曲等曲目由10多位女孩表演時裝走秀,獲得滿堂喝采.<br />
此時身在異鄉的我竟也莫名感動.<br />
我真的相信 : 若您不是身在異國他鄉,您很難有這樣的體驗.<br />
真的非常高興在人生旅程中有這次出國機會,特別是要感謝聯繫安排參訪醫院過程中所有協助幫忙的朋友,在台灣關心我的朋友,及在這邊所有協助的人.當然也要特別感謝Sxxx及您家人陪伴與招待,讓我有這樣重要體驗.<br />
祝所有親朋好友<br />
虎年行大運...身體健康....萬事如意<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/_XzpdLWvupYg/S25AiPUG7fI/AAAAAAAAASA/RdDtB4Ob0lM/s1600-h/%E5%8F%B0%E7%81%A3%E6%9C%8D%E8%A3%9D%E6%99%82%E5%B0%9Ashow(%E5%A4%A7%E5%90%88%E7%85%A7).jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" kt="true" src="http://3.bp.blogspot.com/_XzpdLWvupYg/S25AiPUG7fI/AAAAAAAAASA/RdDtB4Ob0lM/s320/%E5%8F%B0%E7%81%A3%E6%9C%8D%E8%A3%9D%E6%99%82%E5%B0%9Ashow(%E5%A4%A7%E5%90%88%E7%85%A7).jpg" width="320" /></a></div>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com4tag:blogger.com,1999:blog-8003606306363639482.post-33940384864672535322010-02-01T20:48:00.000-08:002010-02-01T20:50:42.874-08:00水劑單一劑量分裝今天(Feb. 1, 2010)有機會看到水劑分裝作業,且徵得兩位技術員同意拍照,特別是我告訴她們我會將我所看到所學儘可能在部落格上與大家分享.<br />
我告訴她們:基於個人隱私關係,所以我不會拍攝有病患資訊的照片,同時也基於個人隱私關係,所以也不會將其個人照片放在網站上.但兩位技術員向我表達她們可以接受且認為很COOL.所以本篇文章也讓讀者有機會看到這邊的夥伴.<br />
先前幾位曾到美國參訪的同仁也帶回類似經驗分享,此時看到也更暸解整各作業細節:<br />
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一,藥品資料輸入:<br />
如同口服藥品一般,在電腦系統裡輸入藥品基本資料,包括 Bar Code, 批號,效期等等資訊.水劑分裝效期以 6 個月為期( 口服藥 1 年 )<br />
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<div class="separator" style="clear: both; text-align: center;"></div>二,校對:<br />
為確保每一單一劑量精確,包括設定分裝ML數外,再利用秤重方式確認,當然重量有一上下允許範圍.<br />
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三,分裝資料列印經藥師再次覆核:<br />
當完成分裝作業後,技術員會將當份分裝作業輸出列印,並讓藥師確認,以確保分裝作業正確.<br />
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四,上架:<br />
當藥師完成簽署確認後,由技術員上架存放.<br />
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在此觀察至今,相信作業流程的設計精神幾乎都是一樣,學習到的一件非常重要的是 : 落實 !yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com2tag:blogger.com,1999:blog-8003606306363639482.post-29836151940966762232010-01-30T14:21:00.000-08:002010-01-30T14:36:14.760-08:00我見我思-UD作業模式由於建置 Pyxis Machine 的作業,因此Kaiser Permanente (以後簡稱 KP),在UD作業模式與筆者成大醫院作業方式及台灣大多數醫院作業方式有極大差異,因此提供筆者所見供與大家分享:<br />
基本上我會說 KP 模式是每日有兩次 Refill (充填 Pyxis Machine)以提供住院病患規律用藥,成大醫院(及台灣大多數醫院)是每日交藥車模式提供住院病患規律用藥.細述如下:<br />
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KP 運作模式<br />
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基礎設備:<br />
KP每一護理站均配製Pyxis Machine,裡頭已依該病房特性建置儲放藥品,供護理人員依Bar Code系統確認藥品與病患身分,執行投藥.<br />
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作業流程:<br />
一,受理處方:<br />
如同先前文章曾向讀者說明,經醫師於電腦系統開立處方後,藥師在電腦系統Verify處方後,該處方才算完成,此時就會有調劑作業程序<br />
二,調劑作業:<br />
1.若此藥已建置儲放於該護理站Pyxis Machine:<br />
技術員(Technician)或藥師就不需調劑給藥,因為護理站Pyxis Machine裡已有此藥品,護理人員就依Bar Code系統確認藥品與病患身分,執行投藥.<br />
2.若此藥並未儲放於該護理站Pyxis Machine:<br />
此時就會列印調配單資訊, 但此資訊是傳遞出該護理站病患需使用該藥品且藥品尚未建置儲放於該護理站Pyxis Machine.<br />
因此,該調配單資訊需經藥師依據其使用頻次及單次量於電腦系統增設該護理站Pyxis Machine的第幾號抽屜? 第幾號藥盒? 儲放多少數量此品項? (設定最大量及最低量)<br />
技術員(Technician)再依據該資訊調劑,捆綁在一起,並經藥師覆核後先暫時存放於固定收集盒內.而後,每小時會有一位技術員(Technician)傳送收集盒內之藥品及調配單資訊到各護理站,並依調配單資訊儲放藥品於該護理站Pyxis Machine的第幾號抽屜,第幾號藥盒,儲放數量.此程序在操作Pyxis Machine時每一環節均需確認並輸入藥品效期.<br />
因此,當此程序完成時,護理人員就依Bar Code系統確認藥品與病患身分,執行投藥.<br />
所以,基本上與成大醫院或台灣大多數醫院作業方式是極大不同.<br />
3.上述所描述的就是當處方第一時間開立時之情境,相信讀者就會問那如何確保護理站Pyxis Machine裡均持續維持適當量供護理人員規律投藥?<br />
在這裡,系統設定每天早上6:30及下午2:00會依據各護理站Pyxis Machine品項設定之存量資訊,只要低於最大量,就跳單列印調配單補充至最大量,經技術員與藥師調劑覆核完成後由技術員配送至護理站,補充入Pyxis Machine.<br />
這裡就有點類似交藥車概念(但仍存在差異)<br />
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三,Bar Code系統<br />
相信許多讀者會問:在台灣仍存在無法每一單一品項均有獨立標示與Bar Code, KP如何讓系統能運作?<br />
筆者發現,KP使用之藥品真的每一個均建置(印製)條碼:(參考圖示)<br />
部分品項類似成大自行分裝單一劑量藥品一樣,且印製條碼在單一包裝上.<br />
大多數藥品都是單一片裝上每一品項就印製條碼.(但筆者發現此標示方式似乎非原藥廠出廠之標示,而是透過另一公司包裝,此部分需再向單位主管請教,讀者可看一下標示方式)<br />
水劑藥品也有單一劑量分裝儀器.及單一包裝.<br />
此外,若確實無法以上述方式印製條碼者,則利用條碼印製儀器產製條碼.<br />
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KP基本上住院病患給藥模式大致如上所述,但細節上其實有許多配套來讓上述作業能正常運作,<br />
筆者也僅就粗略模式作描述,若未能提供完整資訊或讀者有任何疑惑,也歡迎提供提問或提供指導.<br />
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text-align: center;"><a href="http://2.bp.blogspot.com/_XzpdLWvupYg/S2Suro9V0YI/AAAAAAAAANQ/61p0zQfLZqk/s1600-h/UD%E6%B0%B4%E5%8A%91%E5%8C%85%E8%A3%9D%E6%A8%99%E7%A4%BA1(%E5%84%B2%E6%94%BE%E5%8D%80).jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" kt="true" src="http://2.bp.blogspot.com/_XzpdLWvupYg/S2Suro9V0YI/AAAAAAAAANQ/61p0zQfLZqk/s320/UD%E6%B0%B4%E5%8A%91%E5%8C%85%E8%A3%9D%E6%A8%99%E7%A4%BA1(%E5%84%B2%E6%94%BE%E5%8D%80).jpg" width="240" /></a><a href="http://4.bp.blogspot.com/_XzpdLWvupYg/S2StXwve01I/AAAAAAAAANI/T6qXx2_M8_U/s1600-h/%E6%A2%9D%E7%A2%BC%E5%8D%B0%E8%A3%BD%E6%A9%9F.jpg" imageanchor="1" style="clear: left; cssfloat: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" kt="true" src="http://4.bp.blogspot.com/_XzpdLWvupYg/S2StXwve01I/AAAAAAAAANI/T6qXx2_M8_U/s320/%E6%A2%9D%E7%A2%BC%E5%8D%B0%E8%A3%BD%E6%A9%9F.jpg" width="320" /></a></div>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com0tag:blogger.com,1999:blog-8003606306363639482.post-43646036545865032262010-01-24T13:30:00.000-08:002010-01-24T13:55:57.249-08:00我見我思- 針劑調劑作業先前曾聽許多來美國參訪過的同仁提到,針劑藥品調劑作業,由於制度不同所以差異很大,這週持續在一般針劑藥品調劑區(不包含化療藥品)參訪確實更能暸解其差異.<br />
下列就 Kaiser Permanente (以後簡稱 KP),作業模式所見與讀者分享:<br />
<br />
流程:<br />
<br />
一,受理處方:<br />
先前文章曾向讀者說明,經醫師於電腦系統開立處方後,藥師在電腦系統Verify處方後,該處方才算完成,後續包括需立即配製藥品或隔日需配製之藥品,就會依設計模式列印標籤,執行藥品配製.(若有疑義處方藥師正與醫師接洽討論中,系統會可以看到此處方已經過多久尚未被Verify,所以技術員(Technician)也無法調配,當然護理人員就無法給藥.)<br />
這裡與本院最大差異:<br />
1.技術員角色.(法規上台灣都是藥師)<br />
2.程序差異;電腦系統上差異,本院並未將Verify處方程序作為一絕對往下進行關卡.相信在台灣大多數醫院應該與本院作業類似,雖然它不是一是否往下進行絕對關卡,但處方適當性之審核與判斷都是在此時也立即進行,並與醫師溝通.<br />
<br />
二,調配作業:<br />
在 KP,針劑藥品幾乎完全由技術員(Technician)調配後簽名,再由藥師覆核簽名,再由技術員(Technician)配送藥品到護理站.<br />
所謂 " 針劑藥品幾乎完全由技術員(Technician)調配 "指的是 :<br />
(1).技術員(Technician)已完全將藥品配製在稀釋溶液,標示完成調配. (見圖樣)<br />
(2).將 vial 經由可折式管套預先配製在稀釋液前端,護理人員折裂該管套即可使用該藥品溶液,標示完成調配. (見圖樣)<br />
(3).抽取藥品在適當空針內,經 CAP (螺帽鎖)鎖定,標示,標示完成調配. (未拍攝圖樣,同化療抽取藥品於空針內加CAP (螺帽鎖)鎖定<br />
這部分差異就極大,在此制度下與本院或台灣大多數醫院可能存在諸多差異:<br />
1.有多樣化 PRE -MIX藥品可選用,藥廠為提供這樣作業需求,就產出許多PRE-MIX產品經由冷凍存放,待需使用前一日準備作業解凍,標示解凍後使用期限,準備使用.例如Cefazolin 有1 gm或 2 gm PRE -MIX規格,Vancomycin 500 mg or 1 gm D/5 Water, 或在 Normal Saline等等.<br />
2.護理人員不需執行藥品配製溶液作業.(我問藥師,藥師回答在這裡她們也擔心護理人員藥品配製溶液作業錯誤之隱憂,所以認為應該藥師端執行)<br />
<br />
三,藥品標籤標示<br />
藉由電腦作業系統功能之支援,所有送出之藥品都支援 Bar Code作業;若藥廠產出之PRE -MIX藥品,包裝上均有條碼,所以藥品標籤標示就不印條碼,若經由技術員(Technician)依處方選用溶液調配稀釋之藥品,標籤摽示上就會印製條碼,供護理人員投藥前經條碼讀碼確認病患與藥品.<br />
藥品標籤摽示訊息也極盡完整,提供護理人員必要資訊.(參見護理行動電腦工作車)<br />
這部分差異大致上就在條碼的使用及資訊提供的設計. <br />
<br />
四,藥品配送<br />
幾位技術員(Technician)依輪值班,當日所負責工作職掌就會不同,有人專責調配針劑藥品,與此同時有技術員(Technician)負責其他職掌,就會包括即時配送需立即給藥之針劑或口服藥品至護理站放置固定位置.<br />
立即性藥品配送 : <br />
(初步暸解是每小時一次,或專門存放立即性給藥之藥盒滿了就配送)<br />
每天固定給藥時程配送 : <br />
每天下午包括周六,週日 2:30 負責調配針劑之技術員(Technician)就負責配送當日調配好並經藥師覆核之藥品配送至各護理站. <br />
( 感謝 Technician : Lxx 與 Pxx 曾分別帶領我前往配送藥品並適示說明即回答我的疑惑)<br />
口服藥品會被放置在 Pyxis Machine,這點將整體學習後另外撰文說明.....<br />
針劑藥品會被放置在護理站固定存放位置,待護理人員提取使用,這裡就包括一般室溫存放藥品,與需冷藏存放藥品.(參見護理站藥品存放,室溫與小冷藏櫃)<br />
這部分差異當然因設計概念與支援性差異就會有 配送制度差異 與 護理站藥品存放標示差異.<br />
<br />
五,針劑退藥(尚未到口服區觀察學習,排除口服藥品部分)<br />
上述技術員(Technician)配送藥品的同時,會檢查一般室溫存放藥品或與冷藏存放藥品盒內是否存放已過當日日期之藥品? 意即若 1/23配送藥品上去時看到藥盒內有存留 1/22 藥品就視為退藥一併帶回藥局作適當處置.<br />
(若是PRE-MIX產品有一定使用期限,就可回收使用,若是經由技術員(Technician)配製之藥品溶液一律丟棄)<br />
這部分最大差異在護理人員不需填寫任何表單,藥師或技術員(Technician)也完全不需執行退藥確認或退藥入庫等等作業.<br />
相信讀者會與我一樣非常詫異此模式,此部份我也特別詢問藥師,也特別描述本院模式,我大致瞭解到 KP她其實是一很大機構,她提供醫療保險,並提供她的客戶在她所屬的醫療院所提供醫療,所以與台灣健保局,醫療院所,病患之三角模式關係是不同的,所以衍生出來的流程模式就有很大差異。<br />
甚至在剛剛所提的藥品調配部份,技術員(Technician)也不需以病患為一藥品記價個案選用藥品調配,就是以所有個案選用合適總計量調配即可.<br />
當然,這部份就衍生出庫存管理問題,若未依個案計價調配,又未確認退藥入庫,那如何盤點藥品?<br />
此部份也待下回至庫存管理系統學習後再向讀者分享......<br />
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</div>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com4tag:blogger.com,1999:blog-8003606306363639482.post-30795430721283231612010-01-23T19:43:00.000-08:002010-01-23T21:14:55.619-08:00訪 0ld Sacramento<div class="separator" style="clear: both; text-align: center;"><br />
</div>工作不忘娛樂,此次有機會到美國參訪,<br />
儘可能安排讓自己接觸更多美國生活事務,希望讓英文能突飛猛進......<br />
確定參訪 Kaiser Permanente 醫院後(Sacramento, CA),在台灣就上書局買美西旅遊書籍,及透過網路找相關資訊,就看到古色古香的 <br />
Old Sacramento,心想有機會一定去走走,才不虛此行.<br />
上週六就嘗試搭公車探訪,結果未作足功課,竟跑錯路線,不過也有另外驚奇,發現中國城.<br />
今日1/23,週六天氣好轉不再下雨,(已連續下一整週)先上公車網站查訪路線,與班車時間,終於如償造訪古色古香的<br />
Old Sacramento.就像台南新化老街,或安平老街一樣,她嘗試保有古老風貌及許多紀念品店,當然也趁機買些小紀念品準備改天帶回台灣分送親朋,好友,及辛苦的同事....<br />
(若當天需轉換多班不同路線 Bus,買 DAILY PASS 車票,當天隨便你坐,就較划算)<br />
附註:單程2.5美元 , DAILY PASS 車票 6 美元)<br />
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</div>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com0tag:blogger.com,1999:blog-8003606306363639482.post-34925748714036094342010-01-20T01:34:00.000-08:002010-01-20T01:34:31.585-08:00列席委員會....Inpatient Pharmacy Director: Sxxx 安排我參與今日該醫院(KP)Medication Safety Committee及Pharmacy & Therapeutic Committee,運作程序與本院大同小異 .特別是在會議時間控制上掌握的相當好.<br />
Medication Safety Committee時程安排在12:30 - 13:30,幾乎是在13:30結束,<br />
緊接著Pharmacy & Therapeutic Committee進行,時程安排在13:30 - 14:30,結束時間約在14:45,<br />
藥劑部為主要負責籌劃,報告單位.<br />
Inpatient Pharmacy Director: Sxxx ,在Medication Safety Committee特別提出年度提升用藥安全之策略方針 " A - Z Brochure 2010 " , 藉由本文章提供讀者參考.<br />
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<a href="http://2.bp.blogspot.com/_XzpdLWvupYg/S1bNQyO2KSI/AAAAAAAAAGo/b0gA-NccI2I/s1600-h/J+-+Z+Safe+Medication+Administration.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="245" mt="true" src="http://2.bp.blogspot.com/_XzpdLWvupYg/S1bNQyO2KSI/AAAAAAAAAGo/b0gA-NccI2I/s400/J+-+Z+Safe+Medication+Administration.jpg" width="400" /></a>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com3tag:blogger.com,1999:blog-8003606306363639482.post-31873471976744913112010-01-18T21:36:00.000-08:002010-01-18T21:36:41.978-08:00蕭瑟之美 - COTTAGE PARKSacramento的冬天相較於台灣氣候似乎差異不大,這幾天維持在 7-8 度左右,感覺到蠻清爽。<br />
時間相差16小時,以現在時間:台灣時間是1/19 下午 13:00,Sacramento時間 1/18晚上21:00。前些天利用時間來勘察Kaiser Permanente (KP)醫院地理位置時發現,醫院旁邊就座落一座公園:Cottage Park<br />
首先映入眼簾的是空曠蕭瑟的感覺。<br />
難得這段期間到美國醫院參訪,就把自己當成背包客一般優閒的逛了一圈,卻也發現另一端出口的小學與 Apartemnt 居家社區,突然有一種感覺是:平時真的匆匆忙忙的生活步調,未停下腳步看看週遭您會遺漏許多美的事物一般。<br />
Cottage Park裡頭有許多楓樹,但樹葉幾乎都已掉光,呈現光禿禿蕭瑟的美感,我想若在早些時候應該是一片楓紅,應該會更美。<br />
公園裡有許多松鼠跑來跑去,似乎也不怕陌生,還特別擺出 POSE 讓我拍照。<br />
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</div><a href="http://2.bp.blogspot.com/_XzpdLWvupYg/S1VEOxirt3I/AAAAAAAAAGQ/hTRJ9n1PfdE/s1600-h/COTTAGE+SCHOOL.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" ps="true" src="http://2.bp.blogspot.com/_XzpdLWvupYg/S1VEOxirt3I/AAAAAAAAAGQ/hTRJ9n1PfdE/s200/COTTAGE+SCHOOL.jpg" /></a>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com0tag:blogger.com,1999:blog-8003606306363639482.post-85420680082045572982010-01-17T12:38:00.000-08:002010-01-18T20:16:12.898-08:00我見我思-作業流程差異Inpatient Pharmacy Director: Sxxx 非常體貼地安排ㄧ位來自台灣的藥師 Yxxx 帶領我,我相信她的主要目的是降低溝通上障礙,讓我學習成效更佳.謝謝 Sxxx.<br />
(為了提升自己英文能力,我也要求儘可能以英文溝通,不清楚時再輔以中文)<br />
藥師 Yxxx ,目前負責四樓病房臨床藥事服務,<br />
(看起來大同小異,全世界皆然)<br />
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病房體貼地<br />
在護理站設立一專屬位置,專屬電腦供藥師使用,這點在我們那可還沒有.<br />
(有經驗的藥師大概就知道:您可能須要使用電腦或桌椅記錄報告時就會很尷尬,擔心影響其他醫謢人員作業)<br />
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作業流程差異 :<br />
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一,在這裡 " 醫師 " 以電腦系統開立處方後, " 護理人員 " 需 Release 處方,緊接著有專責 " 藥師 "需 Verify 處方,若一切順利,才有藥師調劑該處方,或假若該品項是放置在護理站的 Pyxis Machine, 護理人員才能自該 Pyxis Machine 提取藥品,並經 Bar Code 系統確認藥品與確認該病患確實被開立該藥品才能執行給藥,並且電腦系統完全記錄上述程序每一環節時間.也因此,每一環節人員都非常謹慎需把事情在對的時間完成,若沒有,就會有相關人員要求您,追著你.<br />
若沒有確實執行,後續就會有追蹤報告.<br />
( 恰巧跟隨 Yxxx 時便發現有 Post OP P't 該給 Post OP Prevention antibiotics 而未給,她就必須立即向其 Supervisor 報告,並進一步處置. <br />
" 電腦系統完全記錄上述程序每一環節時間 " 這點相信在台灣大多數醫院可能都還無法達到.<br />
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PS: 若有觀看我文章的台灣藥師,若您醫院或您有任何想法也歡迎回饋訊息,謝謝.<br />
(看起來 Kaiser 的電腦系統設計是非常完善, Yxxx 告訴我這也是在最近才經過第四期轉換配置,才完成, Sxxx 也告訴我 Kaiser 的資訊系統基礎是花許多錢向美國榮民系統醫院購置)<br />
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二,上述程序,完全透過工作人員 " 簽入 " 電腦系統執行,應該就是我們所說的已經完全電子簽章的意思了吧.我相信這也是為什麼在新進人員職前訓練的把關是這麼嚴謹且確實執行 <br />
( 參見 認識 Kaiser 機構文章 )<br />
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PS:若藥師在Verify 處方時發現問題或在 Monitor Vancomycin 使用上需調整劑量等等,任何的Intervention 就直接該系統內記錄.<br />
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受限各項管制措施,有些無法以圖片呈現.後續若不涉及機密或病患隱私等議題考量時,將儘可能在獲得許可時以相片記錄呈現.<br />
考量個人隱私及網路資訊安全問題,相關人員不以全名呈現.請見諒<br />
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本文提供相片是經過一汽車賣場標價約20000美金,心想若在台灣能買來開開也不錯.<br />
( 就喜歡那隻馬的感覺, 哈哈 )<br />
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</div>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com2tag:blogger.com,1999:blog-8003606306363639482.post-75769181861074900062010-01-16T23:45:00.000-08:002010-01-16T23:49:34.898-08:00民以食為天...中華民族炎黃子孫有句話說 : 民以食為天.<br />
( 有沒有發現我不用這樣的字句 : 中國有句話說....., 哈哈,避免尷尬議題 )<br />
在這超不方便的還是三餐問題,<br />
有McDonald's,但沒有炸雞腿,沒有勁辣雞腿堡....(我的最愛)<br />
早餐 ? <br />
稀飯,豆漿,水煎包,肉包,當然沒有,<br />
隨便吃夾心酥餅乾, Coffee,兩天後就不想再吃了,<br />
到醫院吃麵包 + Coffee, 3.5美金<br />
中餐 ?<br />
美國人中餐也很簡單,我也跟著簡單,<br />
一樣餅乾 + Coffee,<br />
醫院也有小小 Cafeteria,倒還有中式口味餐(當然選擇不多)<br />
晚餐 ?<br />
當然是最要好好講究一下,<br />
但也不太習慣,<br />
最近發現一家 Chinese Express,(台灣人開的...蘇媽媽)<br />
雖然,口味重了些,但也只好將就著吃了<br />
一餐約美金 7.58,份量我幾乎可以吃 3次,吃不完打包,<br />
冰在冰箱,隔天用微波爐加熱再吃.(第3次大概不太想再吃)<br />
這家 Motel 功能比 Red Lion Hotel 還好,有冰箱,微波爐,價格又便宜,<br />
直到現在,最好吃的大概要算是<br />
越南餐館的牛肉湯麵了,<br />
( 在台灣還沒吃過越南餐館的朋友,我建議您去吃看看 )<br />
味道好,又有熱湯喝.(小碗約美金6元)<br />
我真的相信,<br />
回去後我真的會瘦一圈.....<br />
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</div>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com0tag:blogger.com,1999:blog-8003606306363639482.post-32370525474853833982010-01-16T22:51:00.000-08:002010-01-16T23:07:43.086-08:00認識 Kaiser 機構SACRAMENTO時間1/6下午3點多接到Kaiser 機構一位Recruitment coordinator 打手機給我,<br />
講了一堆,聽得有些緊張.(當時正坐公車想到Downtown逛逛), <br />
大致上暸解其意思是約見面確認文件與一些必要程序.<br />
為確認不要聽錯造成 Mistake,還是請她發封mail給我,<br />
確定何時,何處,去見誰.<br />
SACRAMENTO時間1/7早上10:00,準時赴約,<br />
確實由一位美女 Rxxxx Bxxxx 為我簡介kaiser願景,任務....等等,<br />
還有特別是病人隱私,感染管制,倫理議題等等,<br />
(一對一)且分別在病人隱私,感染管制,倫理議題議題,<br />
描述完時(以PowerPoint檔簡介)立即有案例測驗,<br />
整個完成時還有一張測驗卷填寫,感覺制度設計還滿不錯,<br />
類似本院敎學中心設計給新進人員進來後多久需完成線上學習課程那樣,<br />
Kaiser的設計是需經由專人講解後確認完成此程序,<br />
才傳遞訊息及接著由單位接續單位的Orientation Check List,<br />
並經Department Manager sign 送出資料,經機構完備程序後,才可正式取得資格.<br />
(包括Students/Interns/Externs/Temporary staff)<br />
這裡是接觸 Kaiser 後,發現與本院制度設計上第一個差異.<br />
過程開始時,我告訴她我的背景,來此目的時,她非常訝異,也覺得很有趣.<br />
整個過程我也儘可能提出互動與描述本院情形,所以,雖然有測驗,但過程非常融洽,<br />
即使測驗的部分她也會提醒我 True or False ,整個過程約1小時又10分鐘.<br />
完成後,我立即致電給藥局 Inpatient Pharmacy Director: Sxxxx, <br />
安排後續行程.<br />
<div style="border-bottom: medium none; border-left: medium none; border-right: medium none; border-top: medium none;">預計下週應該可以到該機構參訪.<br />
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</div>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com0tag:blogger.com,1999:blog-8003606306363639482.post-12050354908600942922010-01-16T22:16:00.000-08:002010-01-16T22:16:40.025-08:00勘察醫院位置,尋找下一住宿地方此次美國行,需感謝許多人幫忙,能在最後敲定參訪醫院.<br />
(考量公開網路文件,不在此逐一述名感謝)<br />
透過 e mail 聯繫敲定 Kaiser 後,從 Google 地圖遠眺其地理位置,<br />
找週遭 Hotel ,並參考顧客給予之評價,作為第一時間下榻的飯店.<br />
因此,第一下榻飯店為 Red Lion Hotel. <br />
(網路訂10天,經打折,含稅後平均一晚價格為78.59美元)<br />
在台灣辦好國際駕照,租3天車,(六,日,一,週日有打折,含保險3天費用87.38美元)<br />
接下來幾天,大致繞完周遭環境後,開始以搭 公車 , 走路 方式量測上下醫院時間,<br />
(在此走路還蠻舒服,路旁都有行人道)<br />
醫院對面有幾家 Apartment, 雖較便宜且交通最方便,<br />
但考量無家具,被子,網路,且感覺非常冷清,吃也不方便又擔心不安全.<br />
所以,不考慮.<br />
(這裡的Apartment, 不像台灣是在大廈裡,它就在冷清大馬路旁,隨時好像有人可以闖進來一樣)<br />
剛開始一直在網路上搜尋附近Hotel,但價位一直無法滿意,<br />
也一度因此懊惱不已,心想難道真需花費這樣大的住宿費用?<br />
總算,皇天不負苦心人,心想也不一定是要 Hotel ,找到一家 Motel 也在附近,<br />
且網路顧客評價也不錯,便前往看了一下,<br />
各方面生活功能都不錯,包括 Bus ,吃飯, 網路,各方面都不差,<br />
當然,價位也還能接受.( 經打折,含稅後平均一晚價格為 44.05美元)<br />
至此,終於解決最重要住宿問題,<br />
緊接著,就是等候通知,正式醫院參訪....<br />
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</div>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com0tag:blogger.com,1999:blog-8003606306363639482.post-90882802738631629382010-01-16T16:23:00.000-08:002010-01-16T23:03:09.053-08:00感恩的心帶著初階破英文,又不常出國的人而言,此次隻身飛往美國是需要極大的勇氣,<br />
我做到了.....,<br />
如果您(妳)與我ㄧ樣,別擔心, JUST DO IT.<br />
(台灣有句話 : 船到橋頭自然直, 電影侏羅紀一句對台不也說 : 生命會自我找出方向)<br />
美國時間 98年12月30日 18:20 飛抵 CALIFORNIA ( 加州 )SAN FRANCISCO( 舊金山 )國際機場,<br />
緊接著需轉機到目的地 SACRAMENTO, CA.<br />
出關時,真是緊張萬分,又適逢紐約炸彈客事件,海關人員盤問許久,<br />
又被帶往另一條檢查線盤問;<br />
免強用破英文回答他的問題:<br />
要停留多久? <br />
3 個月 ?<br />
WHY?<br />
主要目的是?<br />
觀光 ? <br />
( 因未取得美國醫院邀請函,無法辦 J1 簽證,只能說觀光,訪友 )<br />
在台灣有沒有工作 ? 結婚了嗎 ? 有沒有小孩 ?<br />
帶多少錢 ? <br />
$ $ $ $ ? 拿出來看.....<br />
一堆的問題,還好,人長得老實憨厚是有好處的,最後並未搜查行李就過關.<br />
(前一個華人行李一件件拿出來檢查)<br />
出關後趕緊尋找 TERMINAL 3(第 3 航站),轉機不要排得太緊湊是有好處的,<br />
我有充分時間慢慢找 TERMINAL 3.........<br />
還是用破英文問外國人,她(他)也都很熱心的指引,<br />
( but, 要真正清楚還是有困難,最後,一位黑人朋友直接帶我到電梯搭上3樓轉往類似捷運電聯車搭往 TERMINAL 3)<br />
此時,又恰巧碰到一位來自台灣的學生(一看就知道台灣人)<br />
他恰巧同一路線,讓我更安心不少......(不就應驗了 : 船到橋頭自然直嗎 ?)<br />
真正飛抵 SACRAMENTO 機場已是 12/30, 23:25,<br />
此時若真的無人接機不曉得是不是一樣會很順利 ? ( 船到橋頭是不是自然直呢 ? )<br />
這裡真的要感謝 SACRAMENTO 台灣同鄉會會長 陳 X X 大哥.<br />
出發前儘可能透過許多管道尋找是否有人可以接機,<br />
但大多數華人朋友也許住舊金山或住 LA, 就是沒人在 SACRAMENTO ,<br />
原本也想 , 好吧,反正就是一個男人,計程車應該就能到達飯店.<br />
抱持最後小小希望,幾乎是在出發前兩天,經友人兒子介紹,嘗試寫封 e mail 給一個地址連絡,<br />
竟然,在最快時間回覆,一位從未認識的陌生人回覆 : 他可以在晚上23:25去接我.<br />
他就是SACRAMENTO 台灣同鄉會會長 陳 X X 大哥,真的由衷感謝您.<br />
是不是又應驗 : 船到橋頭自然直呢 ?<br />
當然,心存感恩的同時,我也告訴自己:<br />
當別人有困難時,我們若能伸出溫暖的雙手,哪怕是一隻手,<br />
真的會是對方一生中永遠的感謝.<br />
再次謝謝您陳大哥送我到下榻飯店<br />
Red Lion Hotel<br />
1401, Arden Way, Sacramento, CA<br />
<br />
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</div>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com1tag:blogger.com,1999:blog-8003606306363639482.post-63289054931168441502010-01-16T16:10:00.000-08:002010-01-17T23:38:34.834-08:00準備紀念品到美國醫院參訪,總是需見單位主管,醫院服務的藥師,<br />
或者是過程中碰到貴人等等...................<br />
送個小見面禮是一種禮貌,<br />
也做國民外交<br />
如何送禮是一門大學問.<br />
不能送得太貴重,<br />
又要送得有代表性,真是困擾.<br />
出發前,老婆陪我到安平老街,<br />
想說是不是挑些具代表性又紀念性的小禮物,<br />
那天,是假日......<br />
大家可想像安平老街真是人山人海,<br />
結果,平時就不喜歡逛街的我,硬是拉著老婆的手走出安平老街...<br />
路上,買了安平老街特產 " 蝦餅 "回家,自己吃.....<br />
最後,帶了幾樣東西....<br />
向院方申請最具代表性的 : 醫院紀念郵票<br />
丈人送的茶葉<br />
在機場免稅商店選購:<br />
印有台灣地圖的提袋及<br />
前年最夯的電影 " 海角七號 "戴的項鍊....<br />
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</div>夠代表性了吧.<br />
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</div>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com0tag:blogger.com,1999:blog-8003606306363639482.post-53713246628625467912010-01-15T19:00:00.000-08:002010-01-17T23:36:55.567-08:00啟程98/12/30,台灣時間 7:20 AM,星期三<br />
送小孩出門,叮嚀子翔與子祐今天出門後,下課回家時已看不到老爸,<br />
再見面時已是 3 個月後的事,預計 99/4/2 清晨 6:00 飛抵桃園,迎接台灣旭日。<br />
7:45 AM,催促老婆趕快上班,<br />
不要每次都要等到時間到時才匆匆忙忙趕刷上班卡。<br />
出門時兩人彼此擁抱,輕拍她的背,告訴她就當我生意做很大,<br />
到美國出差 3 個月吧。<br />
也許真上了年紀,組員 X珊 常說:組長最愛嘮叨…<br />
免不了,還是叮嚀著…該找媽媽來幫忙的話,不要不願開口…<br />
碰到困難就找我台南這群好友幫忙,不要怕不好意思、<br />
不要怕造成人家麻煩,有困難時妳不說,沒人知道來幫妳…<br />
萬一工作壓力太大受不了,就不要硬撐了...<br />
回頭出門時,我不知道,她淚珠奪眶而出。<br />
搭華航 CI004, 12/30 晚間 23:20 班機飛 SAN FRANCISCO,<br />
安檢入關後已是夜間 9 點多,打電話給她,談話中以為她感冒了,還問她怎了?<br />
她說:不是感冒啦,<br />
是看到我留給家人的叮嚀字條,感動的又哭了,<br />
這時才告訴我,其實早上出門時淚珠已奪眶而出。<br />
這時,心中也酸了起來......<br />
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</div>yslpharhttp://www.blogger.com/profile/13976180440926284563noreply@blogger.com0