의약분업 이후 병원약국 업무 변화 : 분업 이후 병원약국과 지역약국과의 관계 인하대병원 약제부의 협력약국 운영사례를 중심으로

윤혜설 한국병원약사회 2000 병원약사회지 Vol.17 No.4

의료기관 우수약무기준 적용방안 - 의료기관 약제서비스 평가항목 비교를 중심으로 -

윤혜설 한국보건사회약료경영학회 2011 한국보건사회약료경영학회지 Vol.3 No.1

입원환자 조제약의 잉여약 발생요인 분석 : 일개 OCS 운영병원을 중심으로 Based on OCS Operated Hospitals

윤혜설 한국병원약사회 2000 병원약사회지 Vol.17 No.2

In this study the results were gained through analysis the causes of the remainder oral medications in the hospital. 1. Out of the remainder medications, the pure medications appeared to be 43.1% of the total percentage, and the remainder medications, resulted from the incompletion of doctors' inputting the information for cancellation of prescription was 25.2%, and the figure prescription made out to the patients by the nurses and the information they have computerized was 31.7%, which brought out the serious inquiry that appeared to be due unnecessary repetition of the work. 2. 52.4% of the remainder medications appeared to be 43.1% before or after the coming out of hospital at most, so complete re-examination of the process concerning the matters of coming out of the hospital was confirmed to be required in order to reduce the remainder medications. 3. 43% of the remainder medications appeared to be cancelled without the doctors' agreement computerized, and it has made clear that nurses with only oral orders from the doctors generally conduct the administration of medicines. 4. The results of the survey came out to that 75.1% of the remainder medications occurred from the 8 clinical department including GI dept', and 71.3% from the 8 wards beginning East 16 ward. Following suggestions have been made in this hospital according to the result above in order to cut down on the remainder medications. First, current prescription and return programs developed on the assumption of computerization of the doctors' cancellation of the prescription should be amended quickly according to the reality, so the return programs of the official prescription cancellation must be reflected additionally so that the return of un-adiministrated medications that are not paid for yet can be conducted systematically oven if without the doctors' computerization of the cancellation of prescription. Second, it is urgent to establish the systems which can minimize the doctors' oral orders. If oral orders are accumulation, not only prescription the return programs based on the computerization of orders become good for nothing but also the pharmacist office will fill prescriptions that will not be administered, and conclusively more medications out of management will be stretched, in addition, the efficiency and satisfaction with work through the repetition of prescription & return will go down continually. The computerization is not correct, it is needless to say that the printout can not be trusted. Third, the rule of previous notice on day before the coming out of the hospital must be kept after the day of coming out of the hospital is cancelled, it will be considered efficient to reduce the remainder medications a lot. fourth, the pharmacist office should give out the continuous and effective instructions to consultation rooms and wards where the remainder medications occurs a lot. Fifth, prepared for the change of the medical systems intending medical service for the hospitalized patients ultimately, suggestions that the change form the centralized prescription system to decentralized prescription system is pursued and unit Dose System which makes immediate administration of medicines based on the management of medical histories of the patients should be adopted have been just made out.

의약분업이후 병원전문약국과 동네약국 이용자의 만족도 비교

윤혜설 ( Hye Seol Yoon ),유승흠 ( Seung Hum Yu ),손태용 ( Tae Yong Sohn ) 한국병원경영학회 2001 병원경영학회지 Vol.6 No.1

The purpose of the study was to compare patient`s satisfaction on the pharmacy services after introducing the new system of separation of dispensing from prescribing medicines, between those filling their prescriptions from the pharmacy nearby hospitals and those from the pharmacy in their resident areas. To measure patient`s satisfaction, a questionnaire survey was conducted with 354 outpatients who received prescriptions from any of the three university hospitals located in In-Cheon city. Study results showed that geographic accessibility to pharmacy was a main attribute to select pharmacy. Size of the pharmacy and availability of prescription drugs are the second major reasons for pharmacy selection for the patients from the pharmacy nearby hospitals, whereas patronage is the second major reason for those from the pharmacy in resident area. Overall satisfaction was higher among the patients from the pharmacy in resident areas than those from the pharmacy nearby hospitals, mainly due to better facilities(waiting area, public telephone, etc), kindness, cleanliness, shorter waiting time, and pharmacist`s concern about patient`s health. On the other hand, the patients of the pharmacy nearby hospitals showed low satisfaction because of long waiting time and the lack of pharmacist`s knowledge and information about patients` health status and medication history. Patients visiting the hospital that has pharmacy-hospital cooperation system showed higher satisfaction as compared to those visiting the hospital without such system. This study provided an empirical evidence that it would be more advantageous for patients to receive pharmacy services from pharmacies located in their living areas than from pharmacies nearby hospitals. This implies that there is a strong need for adequate strategies to enhance the role of pharmacies in resident areas under the new system of separation of dispensing from prescribing medications.

Roxithromycin 현탁정의 제형변경시 안정성에 관한 연구

이미옥,윤혜설,김용성 한국병원약사회 1999 병원약사회지 Vol.16 No.1

Roxithromycin is one of macrolide antibiotics and is useful the treatment of several types of infections including nongonococcal urethritis, streptococcal pharyngitis, and otitis media. But its extreme bitter taste decreases the compliance of patients. This property has required the development of a proper formula especially for infant use. Roxithromycin tablet is intend to be dissolved in water right before use to remove its bitter taste. We dispense it as powder in the case of under a half tablet of single dose since it is easy to break down. We studied the effect of the change of dosage form from tablet to powder concerning taste and stability. We also carried out experiments to determine the possibility of preliminary preparation as suspension. Powderization of roxithromycin tablet was done to give coarse and fine powder. The samples of both powder were inspected for any difference in color, taste, and appearance and the change of the concertrations of roxithromycin and the impurity was monitored by HPLC at 1, 2, 3, 4, 5, 6, 7, 14, 21, and 31 days after powderization. The suspensions prepared were subject to the same experiment explained above at 4, 8, 12, 16 and 20 hours, 1, 2, 3, 4, 5, 6, 7 and 14 days. It has been shown that there was no notable change in color and appearance while they had bitter taste for both powdered samples throughout the study period. The study also showed that the concentration of roxithromycin was stable in the range of 80-120 %. The suspension had no physical change in appearance and color. On the other hand it had bitter taste and showed instability due to decrease if roxithromycin under 80 % and increase of impurity since 4 hours after preparation. Therefore it can be concluded that roxithromycin tablet is appropriate dosage form in terms of taste and safety when administered as aqueous solution right before use.

Medication Error 감소를 위한 C.Q.I

강윤경,윤혜설,이지선,임옥정,이영아,구본일 한국의료QA학회 2009 가을학술대회 Vol.2009 No.3

지역병원에서의 중복처방경고시스템 개발을 통한 약품사용안전성 개선방안

최선주,이지선,윤혜설 한국의료QA학회 2008 가을학술대회 Vol.2008 No.2

지역병원에서의 중복처방경고시스템 개발을 통한 약품사용 안전성 개선방안

최선주,이지선,윤혜설 한국병원약사회 2007 병원약사회지 Vol.24 No.2

Purpose: We desired to detect the cause of the duplicate prescriptions which occurrs in Cheong-ju St. Mary's hospital, and to develop effective warning program which can prevent the duplicate prescriptions. The purpose of this study is to reduce duplicate prescription, ultimately, to elevate the safety and appropriateness of drug use by this system. Methods: As preliminary research before developing a program, the duplicate prescriptions which transmitted with FAX from community pharmacies to the Cheongju St. Mary's Hospital were retrospectively analyzed. We developed warning program for the duplicate prescriptions. This warning program was operated from August 2006. The duplicate prescriptions retrospectively analyzed for the period of 2 months prior to and after the implementation of duplication warning program. After improving a program, data analysis was continued in 2007. Results: After warning system for the duplicate prescriptions was implemented, the average daily frequency of the dup licate prescription was reduced from 1.16 cases to 0.47 cases. The daily frequency of the duplication generated from different ambulatory clinics was decreased from 0.56 cases to 0.14 cases(75% reduction). The daily frequency of duplication generated from the single ambulatory clinic was decreased from 0.6 cases to 0.33 cases (45% reduction). The daily frequency of same-drug coded duplication decreased from 0.84 cases to 0.39 cases (53.6% reduction). Daily frequency of duplication in the drugs with similar medical effect was decreased from 0.08 cased to none.

약국서비스 만족에 영향을 미치는 요인 분석 : 환자체감시간과 실 조제시간 비교를 중심으로

박성희,서준규,윤혜설,홍진영,박군제 한국의료QA학회 1998 한국의료질향상학회지 Vol.5 No.2

Purpose : To shorten processing time for variety of medical affairs of the patient at the outpatient clinic of a big hospital is very important to qualify medical care of the patient. Therefore, patient's waiting time for drug delivery after doctor's prescription is often utilized as a strong tool to evaluate patient satisfaction with a medical care provided. We performed this study to investigate factors influencing patient satisfaction related with waiting time for drug delivery. Methods : The data were collected from July 21 to August 12, 1998. A total 535 patients or their families who visited outpatient clinics of Inha University Hospital were subjected to evaluate the drug delivery time and the level of their satisfaction related, which were compared with those objectively evaluated by Quality Improvement Team. The reliability of the scale was tested with Cronbach's alpha, and the data were analyzed using frequency, t-test, ANOVA, correlation analysis and multiple regression. Results : The mean drug delivery time subjectively evaluated by the patient (16.1 13.0 min) was longer than that objectively evaluated (10.9 7.6 min) by 5.2 min. Drug delivery time objectively evaluated was influenced by the prescription contents, total amount or type of drug dispensed, etc, as expected. The time discrepancy between two evaluations was influenced by several causative factors. One of those proved to be a patient's late response to the information from the pharmacy which the drug is ready to deliver. Interestingly, this discrepancy was found to be more prominent especially when waiting place for drug delivery was not less crowded. Other factors, pharmaceutical counseling at the pharmacy, emotional status or behavior of a patient while he waits for the medicine, were also found to influence the time subjectively evaluated. Regarding the degree of patient satisfaction with the drug delivery, majority of patients accepted drug delivery time with less than 10 min. It was also found to be influenced by emotional status of the patient as well as kindness or activity of pharmaceutical counselor. Conclusion : The results show that, besides prescription contents, behavior pattern or emotional status of a patient, environment of the waiting place, and quality of pharmaceutical counseling at the pharmacy, may influence the patient's subjective evaluation of waiting time for drug delivery and his satisfaction related with the service in the big hospital. In order to improve patient satisfaction related with waiting time for drug delivery, it will be cost effective to qualify pharmaceutical counseling and information system at the drug delivery site or waiting place rather than to shorten the real processing time within the pharmacy.

Major Depressive Disorder 질환성 노인 환자들의 치료제 평가

임옥정,이옥상,윤혜설,최경식,임성실 대한약학회 2013 약학회지 Vol.57 No.2

Depressive disorders are the most common psychiatric problem in the elderly. Most depression treatment guidelines emphasize treatment with antidepressant medication and recommend that benzodiazepine use be minimized for limited period, particularly to elderly patients. In order to evaluate appropriate use of antidepressants and benzodiazepine, retrospective review of prescriptions was performed. The study population are older than 65 years who had been newly diagnosed with major depressive disorder in specialty mental health at a community general hospital from January 1 st , 2007 to October 31 th , 2012 (N=373). Initial antidepressant accounted for 89.5% with SSRI, and escitalopram accounted for 60.9% of SSRI group. 79% or more of the patients were prescribed the recommended dosage. The maintenance rate for 4 weeks of initial antidepressant was 48% and 6 weeks was 39%. Treatment-discontinuation rate was 68% at 3 month. Alprazolam (short acting benzodiazepine) was prescribed the most, followed by clonazepam (long acting benzodiazepine) and then diaz- epam. 55% of patients received a duplicated prescription for short acting plus long acting benzodiazepine. 61% of patients used long acting benzodiazepines. Prescribed dosages of benzodiazepines were commonly within a recommended range, while no one was prescribed a appropriate period (up to 2 weeks) except for the early discontinued patients. Appropriate use of zolpidem was only 16.2%. The depressed elderly treated in specialty mental health mostly received long-term treat- ment with benzodiazepines in combination with antidepressants, guideline recommendations was not followed. Multi- disciplinary interventions like audit and feedback of benzodiazepine use are needed and education for the elderly is needed to properly maintain antidepressant treatment.