开展神经内科老年患者药学服务的案例分析

目的:探索临床药师向神经内科老年患者提供药学服务的切入点及工作体会,以提高老年人用药安全。方法:结合临床药师在神经内科参与制定SAP患者抗菌治疗方案、老年人用药剂量、围术期抗栓药物的应用以及提高患者依从性的典型案例讨论,总结药学服务工作实践经验体会。结果:临床药师通过会诊或主动监护上述典型病例,与医师形成一个治疗团队,在患者的住院治疗中发挥了作用,提高了临床治疗的有效性及合理性。结论:临床药师要从传统、被动的药学思维模式转变为以疗效与用药安全的临床思维模式,积极、主动地结合临床,才能及时发现并解决用药中出现的问题,联合医师选择更合理的治疗方案,体现其在临床诊疗中的价值地位。

Practice of pharmaceutical care on elderly patients in neurology department

OBJECTIVE To explore the approaches of clinical pharmaceutical care for elderly patients in neurology department to improve safe clinical medication. METHODS The classic cases with clinical pharmaceutical participation in SAP patient monitoring, medication dosage, antithrombotic drugs use in perioperative period and improved compliance of patients were reported to summarize experiences in pharmaceutical care and explore the work content and pattern. RESULTS Clinical pharmacists formed a team with the clinicians for clinical treatment through pharmaceutical care, which played an important role in the hospitalization patients, and made the effectiveness and rationality improvement of clinical treatment. CONCLUSION Clinical pharmacists should change from the traditional and passive thinking mode to the clinical thinking mode of pharmaceutical efficacy and safety, positively and actively combine the clinical practice to find and solve the problems in the drug therapy, and choose more reasonable treatment plan with the physician, which can reflect the value of clinical pharmacist in clinical diagnosis and treatment.