기관지 천식

허영설 약업신문사 2000 의약정보 Vol.2000 No.2

항암제 주사 조제 오류의 발생률, 유형 및 원인분석

허영설,강민경,김희세,송영천 한국병원약사회 2012 병원약사회지 Vol.29 No.1

The objective of this study is to investigate the incidence, types, stages and causes of preparation errors in intravenous chemotherapeutic agents in order to prevent medication error and improve patient safety. The study was performed in the Outpatient Department of Pharmacy in ASAN Medical Center during a nine month period from January to September 2011. Preparation errors were both selfreported and non-self-reported. Analysis included 99,085 preparations, and preparation errors were detected in 155 preparations (0.16%, 95% CI=0.10%-0.21%). Common types of errors were incorrect dosage of drugs (18%), incorrect volumes of diluents (14%), and spills in the process of preparation (13%). The most common stages of error occurrence were the preparing stage (51%) and checking stage before preparation (17%). Causes included mistakes in device operation (16%), process violation (16%), and incorrect identification of drugs or diluents (13%). Other causes included poor quality of medication (26%), unusual processes of preparation (15%), and insufficient support of computerized systems (27%). To prevent error, working routines should be established for the through verification of the systems, and to analyze, change, and monitor the processes and environments.

외래 항암주사병동 복약상담 현황 및 만족도 조사를 통한 복약상담 개선 방안

차현경,류수경,허영설,김희세,송영천 한국병원약사회 2012 병원약사회지 Vol.29 No.2

In this study, we measured the satisfaction and demand of counseling by a survey to cancer center, which counseled patient and family members, and it aimed to study the way to in which improvements of the medication counseling could be made, based on an analysis of pharmacist’s intervention. Satisfaction of counseling, contents, when patient want to be counseled, counseling time, and number of counseling were surveyed by 148 patients, who were counseled for 3 weeks, from May 12 to June 1 in 2011, and pharmacist’s interventions were analyzed. Providing information (25 cases) is mostly rated in the content of pharmacist interventions of surveyed patients. In this satisfaction of the survey results, the most patients answered that pharmacists’medication counseling is helpful for getting the information of the medicine’s name, the effects, and usage. The side effects are mostly indicated with what they want to be counseled, by 74 patients (51%), patients’requirement was diversely shown in the question about asking what the proper number for counseling is. Most patients were satisfied with the questions,which were asked of counseling, kindness and satisfaction level. On this basis, improving medicine explanation, adjusting the number of counseling times, according to patients need, developing standardized patients counseling software and managing it, we are expecting that the effective and high quality pharmacist medical counseling will be achieved.

약사의 항암제 처방감사를 통한 약물오류 예방

강민경,윤선혜,허영설,김희세,송영천 한국병원약사회 2011 병원약사회지 Vol.28 No.3

The purpose of this study was to analyze chemotherapy-related medication errors detected by pharmacist in outpatient department and to evaluate efficacy of new alert system in chemotherapy monitoring program to prevent them. Finally, we evaluated the efficacy of pharmacists’prescription review. The study was performed at Asan Medical Cancer Center pharmacy from October 2008 to September 2010. We reviewed medication orders by using chemotherapy monitoring program and Electronic medical record (EMR), and compared the quantity and quality of reviewing medication orders and intervention after applying new alert system. During the study period, the number of medication monitoring increased from 47,928 to. 59,618. And, the frequency of pharmacists’interventions increased, especially anticancer-drug dosage related interventions increased from 31% to 46%. When we analyzed the reason of dosage errors,laboratory data related errors increased from 9% to 16%. We confirmed that pharmacists’chemotherapy monitoring and intervention improved qualitively and quatitatively after applying new alert system. And, it prevented potential harm due to medication errors.

Cetuximab 주입관련반응의 발생 빈도 및 관련 인자 분석

장호석,강민경,허영설,김희세,곽혜선,송영천 한국병원약사회 2013 병원약사회지 Vol.30 No.1

Monoclonal antibody treatments can result in severe infusion reactions. Among these, cetuximab, mouse-human chimeric monoclonal antibody reported 15~20% infusion reactions (severe infusion reactions 3~5%). However, there are no actual reported incidences in Korea, and little information regarding the prevention, management or outcomes of infusion reactions. This study represents one of the first attempts to describe the clinical consequences regarding the incidence rates of infusion reactions, effect of premedication and test dose. A retrospective chart review was conducted in Asan Medical Center. Eligible patients were treated with cetuximab as either single agents or in combination with additional chemotherapy. Case searches were conducted by electronic medical records from June 2006 to October 2010. Source documents were evaluated for infusion reactions based on the Common Terminology Criteria for Adverse Events version3.0 (CTCAE v3.0). A total of 336 patients (215 men and 121 women) with the mean age of 56 years (27-76 years) were enrolled in this study. 11 patients were identified with infusion reactions. Mild and moderate infusion reactions are 9 (≤grade2, 3.3%) and severe infusion reactions are 2 (grade4, 0.6%). In premedication, 7 of 285 patients (2.5%) who received antihistamine were identified with a infusion reaction, while 4 of 51 patients (15.2%) who received antihistamine and corticosteroid (p=0.63). 4 of 84 patients (4.8%) treated with monotherapy and 7 of 252 patients (2.8%) treated with combination therapy suffered from infusion reaction (p=0.712). Patients with the administration of test dose (n = 49) experienced infusion reactions were 5 people. Further, 3 of these 5 patients (60%) were identified with infusion reactions at the main dose, not test dose. In addition, 6 patients of the past 2 mg/ml formulation with the unfiltered group (n = 288) (2.1%) and 5 patients of the present 5 mg/ml of the formulation was filtered (n = 48) (10%) were identified with a infusion reactions (p=0.915). It was difficult to find significant factors relating to the infusion reactions because incidences of cetuximab infusion reactions were lower than the previously reported. However, we found that antihistamine with corticosteroids as a premedication tended to reduce infusion reactions and the test dose is not valid.

주사제 Unit Dose System의 평가

김정태,유성길,천영주,허영설 한국병원약사회 2003 병원약사회지 Vol.20 No.4

국내병원의 항암주사제 조제환경 및 약사 업무 현황 조사

강민경,박향민,이연주,김다진,이윤선,여미진,이연홍,문진영,허영설,김재연 한국병원약사회 2015 병원약사회지 Vol.32 No.2

Purpose : The American Society of Health-System Pharmacists has provided guidelines on handling hazardous drugs and updated its new and continuing concerns for health care workers. However, there are no such guidelines or regulations in Korea. This study aims to evaluate the work environment and the safety of healthcare workers during the preparation of antineoplastic agents in Korean hospitals. Methods : We invited a total of 110 hospitals with more than 500 beds to participate in our survey. Twenty nine hospitals participated. The self-completion questionnaire covered work place issues, the number of antineoplastic agent preparations, equipment and environmental quality control, and training about the handling of hazardous drugs. Results : There are three hospitals where the daily compounding number reached more than 600 and the average number per person was 36.5. The preparation room for hazardous drugs at nine hospitals remained positive or equal pressure. In addition, nine hospitals used a clean bench, which is not biologic safety cabinet. None of the 29 hospitals conducted an environmental sampling test to detect hazardous drugs and most of the hospitals performed an efficiency test of the biologic safety cabinet. All of the hospitals conducted personnel training and education about the safe handling of antineoplastic drugs but the length of the training period varied. In addition, none of the hospitals evaluate the health status of workers. Personal protective equipment included gowns, gloves, masks, hair caps and arm covers but not a respirator. The type of equipment and usage times varied. Most of hospitals complied with continuing preparation-compounding times of less than 2.5 hours. Conclusion : This was the baseline study to evaluate the work place and worker safety for the preparation of antineoplastic drugs. The result of our study demonstrates that it is necessary to establish standardized guidelines and improve working conditions for the handling of hazardous drugs in Korean hospitals.