肾内科临床药师在药物整合服务中的实践探索

目的通过临床药师在肾内科对药物整合(medication reconciliation)的实践,探讨临床药师在药物整合中的重要作用。方法对2014年1月18日-2月18日入院的20名患者进行药物整合,主要通过询问患者近1年内的用药情况,对比入院医嘱和药师询问结果,分析存在差异的原因。结果药品数量与入院医嘱不相符率占60%,药品产地不同占55%,药师问诊的准确率更高。结论临床药师在药物整合中起到重要的作用,通过加强医生和患者对药物整合的重视,以及加强医院系统网络建设等措施可以更好地帮助医务工作者实行药物整合服务,减少用药差错的产生。

Practice of medication reconciliation services by clinical pharmacists of nephrology department

Objective To discuss the important role of clinical pharmacists in medication reconciliation through the practice of clinical pharmacists of nephrology department. Methods The medication reconciliation serviced for the patients newly admitted to nephrology department was carried out through the way of interrogation.The difference and the causes between the results of pharmacist's interrogation and the doctors' were analyzed. Results 20 patients were enrolled.The quantity was not consistent with what hospital doctor's advice rate (60%),drugs produced in different areas (55%),different producing areas pharmacist had higher accuracy. Conclusion It had certain effect on medication management and could reduce the ADR.Clinical pharmacists and doctors should pay more attention on the medication reconciliation,strengthen the ability of interrogation to improve patient compliance and establish a complete medication reconciliation system.