门诊用药安全监测与智能化用药审核模型的应用评价

目的开发合理用药软件系统,应用智能化信息技术提高电子处方审核质量,协助药师开展工作,促进安全合理用药。方法在原有医院信息系统的基础上,以及中文操作系统环境下,采用C++程序编辑工具和用药系统,结合条形码技术,开发医院门诊药房自动化合理用药监管软件。结果窗口合理用药软件及合理用药处方审查和报告系统的应用,可实时监测处方不安全用药状况,为门诊患者安全用药提供客观的数据支持。结论信息化技术结合临床用药监测需求开发软件,可方便、快捷地辅助药师审核处方,促进合理用药,是药师开展临床安全用药监测与评价的药学服务工具。     

静脉用药集中调配中心TPN审方模块软件的研发

目的:研发监测全胃肠外营养(total parenteral nutrition,TPN)、评价影响全胃肠外营养用药安全因素的合理用药审方软件,协助责任药师开展全胃肠外营养合理用药审查工作。方法:随机抽取我院外科药房2010年1-9月已开展静脉用药调配科室的住院病人TPN医嘱记录,针对大量使用电解质对TPN稳定性的影响、液体补给、热量供给、热氮比、糖脂比、配伍禁忌等问题,在Wins/XP平台,中文操作系统环境下,基于医院信息系统(HIS),以Delphi程序编辑工具和SQL favor 2005数据库系统开发医院TPN审方系统模块。结果:我院药品保障中心根据TPN合理用药审查要求,自主开发了全胃肠外营养审方系统模块软件,主要包括TPN监测效果评价、单病人TPN的详细医嘱信息、单病人TPN审方指标明细、TPN基本营养配比结构图、TPN审方指标的雷达图5大部分。可实时监测TPN临床用药状况,详实记录和评价TPN的合理性,同时对不合理TPN医嘱的原因和相关因素进行关联性评价,为提高医院TPN用药安全提供客观的数据支持。结论:该软件操作简便、信息记载全面、评价指标明确、图表分析形象化,为药师TPN审方提供了强有力的信息化数据支持。     

临床药师在ADR监测中的作用

医院是开展ADR监测工作的基层单位，大多数医院的临床药学室承担着ADR监测工作。临床药师通过参与临床用药方案的制定来指导临床合理用药，是ADR监测工作的具体执行人。因而药师在促进临床合理用药，保障人民群众用药安全；开展药品安全性评价，有效减少和防止药品不良反应的重复发生；促进临床药学学科的发展等方面起着不容忽视的重要作用。     

药师应用合理用药支持软件纠正不合理用药的实践和效果

目的：探讨药师如何更好地应用合理用药支持软件来纠正临床不合理用药情况,提高用药水平。方法：介绍大连医科大学附属第二医院对该软件的应用情况,精选相关不合理用药案例对监测效果进行分析。结果：通过药师的干预,纠正了许多沿袭已久的临床不合理用药,提高了医师的用药水平。结论：通过合理用药软件的使用,结合建立合理用药制度,能够更好地发挥药师在纠正临床不合理用药中的作用。     

合理用药监测系统软件对临床药师的指导作用

［摘要］为提高医院合理用药水平,探索以患者为中心的合理用药模式和药师工作模式,开展以合理用药为核心的临床药学工作,尝试性开展每日合理用药监测系统（PASS）软件监测与药师下临床相结合的模式。工作自开展以来,临床药师以PASS软件监测为指导,参与临床疾病诊断、治疗,提供药学技术服务,取得了显著的效果。     

临床药师在ADR监测中的作用

医院是开展ADR监测工作的基层单位 ,大多数医院的临床药学室承担着ADR监测工作。临床药师通过参与临床用药方案的制定来指导临床合理用药 ,是ADR监测工作的具体执行人。因而药师在促进临床合理用药 ,保障人民群众用药安全 ;开展药品安全性评价 ,有效减少和防止药品不良反应的重复发生 ;促进临床药学学科的发展等方面起着不容忽视的重要作用。1　临床药师开展ADR监测可提高临床合理用药水平药品具有两重性 ,在治疗疾病的同时 ,也会对机体产生或多或少的危害 ,许多ADR是在正常用法用量下发生的 ,这些ADR有的是由于药品的自身因素 ,有…     

药师在我院药品安全性监测中的作用

目的探讨药师在医院药品不良反应(ADR)监测和药品安全警戒中的责任和作用。方法采集医院2006年至2009年的药品不良反应报表数据、合理用药监测(PASS)软件审查数据和处方评价数据,并进行汇总分析。结果医院药品不良反应报表数量和质量呈逐年上升趋势,上报形式得到改进,医院对此项工作的重视程度提高,及时发布药物警戒信息,有效预防了药品不良事件的发生,提高了临床医师合理用药水平。结论药师应发挥更大的作用,有效促进药品安全监测工作的开展,推动医院的安全合理用药。     

医院建立临床药师制的探讨

目的：医院临床应科学、合理用药，保证用药安全、有效、经济。方法：建立临床药师制，开展临床药学工作。结果：医院临床科学、合理用药。结论：只有建立临床药师制，才能保证用药安全、有效、经济，保障人民身体健康。     

临床药学服务在合理用药中的作用

目的：探讨临床药师开展临床药学服务在医院合理用药中发挥的作用。方法：通过具体实例,对我院临床药师开展的临床药学服务工作进行总结。结果：我院临床药师在药物治疗、药物监测、药品不良反应监测及用药咨询等方面发挥着重要作用,取得明显效果。结论：临床药学服务在促进合理用药和医院药学发展中起着重要作用。     

合理用药监测系统应用实践与举例

目的:探讨和交流医院加强PASS系统(合理用药监测系统)管理模式。方法:通过对软件管理模式及监测结果介绍,辅以临床实例分析,展示该软件在医院的运行状况。结果:应用PASS系统能够对医生的处方行为进行干预,避免大量用药错误的发生,促进合理用药进程。结论:药师通过合理用药软件干预临床处方过程,PASS系统在临床合理用药方面可发挥重要作用。     

小型医院临床药学服务工作实践

目的:在小型医院开展临床药学服务,促进临床用药更加安全、有效、经济、合理。方法:通过药学咨询、参与治疗、合理用药三个方面,在小型医院进行临床药学服务工作实践。结果:临床药师通过上述药学服务实践,比较好的促进了我院临床合理用药。结论:临床药师在促进小型医院合理用药、减少药物不良反应、降低不合理费用支出等方面发挥了很好的作用。     

处方点评实践工作中典型案例分析

目的通过处方点评工作中暴露问题,促进临床合理用药。方法每月随机抽取2007年8月～2008年10月门诊处方100张,进行统计点评。结果门诊不合格处方占2．5％,不合理处方占18％。结论药师处方点评实施了对临床用药监控,提高医生用药水平,保障用药安全。促进药师学习掌握专业知识技能,提高判断不合理用药的能力。     

Application of intervention mapping to develop and evaluate a pharmaceutical discharge letter to improve information transfer between hospital and community pharmacists

BackgroundInsufficient information transfer is a major barrier in the transition from hospital to home. This study describes the systematic development and evaluation of an intervention to improve medication information transfer between hospital and community pharmacists.ObjectiveTo develop and evaluate an intervention to improve the medication information transfer between hospital and community pharmacists based on patients', community and hospital pharmacists’ needs.MethodsThe intervention development and evaluation was guided by the six-step Intervention Mapping (IM) approach: (1) needs assessment to identify determinants of the problem, with a scoping review and focus groups with patients and healthcare providers, (2) formulation of intervention objectives with an expert group, (3) inventory of communication models to design the intervention, (4) using literature review and qualitative research with pharmacists and patients to develop the intervention (5) pilot-testing of the intervention in two hospitals, and (6) a qualitative evaluation of the intervention as part of a multicenter before-after study with hospital and community pharmacists.ResultsBarriers in the information transfer are mainly time and content related. The intervention was designed to target a complete, accurate and timely medication information transfer between hospital and community pharmacists. A pharmaceutical discharge letter was developed to improve medication information transfer. Hospital and community pharmacists were positive about the usability, content, and comprehensiveness of the pharmaceutical discharge letter, which gave community pharmacists sufficient knowledge about in-hospital medication changes. However, hospital pharmacists reported that it was time-consuming to draft the discharge letter and not always feasible to send it on time.The intervention showed that pharmacists are positive about the usability, content and comprehensiveness.ConclusionThis study developed an intervention systematically to improve medication information transfer, consisting of a discharge letter to be used by hospital and community pharmacists supporting continuity of care.     

Hospital pharmacy practice in Saudi Arabia: Drug monitoring and patient education in the Riyadh region

BackgroundThe purpose of this national survey is to evaluate hospital pharmacy practice in the Riyadh region of Saudi Arabia. The results of the survey pertaining to the monitoring and patient education of the medication use process were presented.MethodsWe have invited pharmacy directors from all 48 hospitals in the Riyadh region to participate in a modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire. The survey was conducted using similar methods to those of the ASHP surveys.ResultsThe response rate was 60.4% (29/48). Most hospitals (23, 79%) had pharmacists regularly monitor medication therapy for patients. Of these hospitals, 61% had pharmacists monitoring medication therapy daily for less than 26% of patients, 17% monitored 26–50% of patients and 22% monitored more than half of patients daily. In 41% of hospitals, pharmacists routinely monitored serum medication concentrations or their surrogate markers; 27% gave pharmacists the authority to order initial serum medication concentrations, and 40% allowed pharmacists to adjust dosages. Pharmacists routinely documented their medication therapy monitoring activities in 52% of hospitals. Overall, 74% of hospitals had an adverse drug event (ADE) reporting system, 59% had a multidisciplinary committee responsible for reviewing ADEs, and 63% had a medication safety committee. Complete electronic medical record (EMR) systems were available in 15% of hospitals and 81% had a partial EMR system. The primary responsibility for performing patient medication education lays with nursing (37%), pharmacy (37%), or was a shared responsibility (26%). In 44% of hospitals, pharmacists provided medication education to half or more inpatients and in a third of hospitals, pharmacists gave medication education to 26% or more of patients at discharge.ConclusionHospital pharmacists in the Riyadh region are actively engaged in monitoring medication therapy and providing patient medication education, although there is considerable opportunity for further involvement.     

1例婴儿药物超敏反应综合征的药学监护

目的：探讨临床药师对婴儿药物超敏反应综合征的药学监护要点,以提高对治疗药物的管理水平。方法：临床药师参与1例婴儿药物超敏反应综合征的治疗,对可能出现的药物相互作用及不良反应进行分析和药学监护,促进患儿病情转归。结果：经过包括临床药师在内的诊疗团队共同评估,调整治疗方案,提出用药建议,为患儿及家属提供药学监护和用药宣教,患儿好转出院,随访期间病情没有复发。结论：临床药师在药物超敏反应综合征治疗中可发挥药学专业优势进行药物精细化监护管理,提高疗效,以保障婴幼儿用药安全。     

儿科临床药师开展创新药学服务的思考与实践

目的:探讨儿科临床药师针对儿童患者及家长进行创新药学服务的实践及思考.方法:通过开展儿科专科药学门诊、床旁用药教育、社区儿童用药宣教和线上服务等创新药学服务项目,探讨儿科专科临床药师在药学转型发展中的作用.结果:37.4％的儿科药学门诊患者来自医师转诊,可实现临床医师和药师在专业知识上的互补,充分发挥专科临床药师的作用...     

临床药师对肿瘤科药物治疗的药学监护

目的:探讨临床药师在肿瘤科开展药学服务的工作模式和切入点。方法:结合肿瘤科临床药师在药物治疗、给药环节及患者用药教育等方面的工作体会,总结其具体工作内容和模式。结果:我院临床药师在药物治疗方案、药物相互作用、药品不良反应监测、对护士的指导、用药咨询、营养支持和药患沟通等方面发挥了重要作用,取得了明显效果。结论:临床药师只有深入临床,按照适宜的工作流程,才能切实做好临床药学服务。     

Clinical pharmacy services, hospital pharmacy staffing, and medication errors in United States hospitals

The direct relationships and associations among clinical pharmacy services, pharmacist staffing, and medication errors in United States hospitals were evaluated. A database was constructed from the 1992 National Clinical Pharmacy Services database. Both simple and multiple regression analyses were employed to determine relationships and associations. A total of 429,827 medication errors were evaluated from 1081 hospitals (study population). Medication errors occurred in 5.22% of patients admitted to these hospitals each year. Hospitals experienced a medication error every 22.04 hours (every 19.13 admissions). These findings suggest that at minimum, 90,895 patients annually were harmed by medication errors in our nation's general medical-surgical hospitals. Factors associated with increased medication errors/occupied bed/year were drug-use evaluation (slope = 0.0023476, p=0.006), increased staffing of hospital pharmacy administrators/occupied bed (slope = 29.1972932, p<0.001), and increased staffing of dispensing pharmacists/occupied bed (slope = 19.3784148, p<0.001). Factors associated with decreased medication errors/occupied bed/year were presence of a drug information service (slope = -0.1279301, p<0.001), pharmacist-provided adverse drug reaction management (slope = -0.3409332, p<0.001), pharmacist-provided drug protocol management (slope = -0.3981472, p=0.013), pharmacist participation on medical rounds (slope = -0.6974303, p<0.001), pharmacist-provided admission histories (slope = -1.6021493, p<0.001), and increased staffing of clinical pharmacists/occupied bed (slope = -9.5483813, p<0.001). As staffing increased for clinical pharmacists/occupied bed from the 10th percentile to the 90th percentile, medication errors decreased from 700.98 +/- 601.42 to 245.09 +/- 197.38/hospital/year, a decrease of 286%. Specific increases or decreases in yearly medication errors associated with these clinical pharmacy services in the 1081 study hospitals were drug-use evaluation (21,372 more medication errors), drug information services (26,738 fewer medication errors), adverse drug reaction management (44,803 fewer medication errors), drug protocol management (90,019 fewer medication errors), medical round participation (42,859 fewer medication errors), and medication admission histories (17,638 fewer medication errors). Overall, clinical pharmacy services and hospital pharmacy staffing variables were associated with medication error rates. The results of this study should help hospitals reduce the number of medication errors that occur each year.     

我院2013年上半年药物咨询情况分析

目的：开展门诊药物咨询服务,促进患者安全、合理用药。方法：对我院2013年1—6月期间临床药师登记完整的432例门诊药物咨询信息进行统计分析。结果：门诊药物咨询人群中以儿童家长居多,其次是孕妇;咨询内容以用法用量居多,其次是注意事项与孕妇用药安全,另外一些特殊剂型使用药物的咨询逐渐增多。结论：通过开展药物咨询服务,逐步提高门诊患者用药的安全性、有效性及依从性,同时不断提高临床药师的业务水平。     

基层医院急诊患者用药监护需求调查及影响因素分析

目的探讨基层医院急诊患者用药监护需求程度及影响因素,寻找急诊患者用药监护的针对人群及切入点。方法自行设计调查表,使用SPSS11.5软件对数据进行统计学分析,了解急诊患者用药监护需求程度及影响因素。结果急诊患者用药监护需求程度差,主要原因在于患者在院时间短,监护难度大,对于医生治疗的依赖性及信任度明显高于药师用药指导;患者病情严重度及对疾病相关知识的掌握程度,也是影响需求程度的重要原因。结论为以后能顺利开展急诊患者用药监护,要逐渐加强患者安全用药教育宣教,并对临床药师用药监护的意识及能力开展培训。