Evaluation of the symptoms, adherence and satisfaction after pharmaceutical care at asthma clinic for outpatient

In the present study, we investigated whether counseling at an outpatient asthma clinic improved asthma symptoms, adherence and patient satisfaction: The asthma control test (ACT) and asthma control questionnaire (ACQ) were used to assess subjective symptoms, 10-item version of the drug attitude inventory (DAI-10) was used to determine medication adherence, and 8-item Japanese version of the client satisfaction questionnaire (CSQ-8J) was used to ascertain patient satisfaction. All scores of inhalation technique, PEF (peak expiratory flow) value/predicted PEF value (%), ACT, ACQ and DAI-10 in 26 patients with asthma increased after counseling at the outpatient asthma clinic compared to those before counseling. The average CSQ-8J score of 28 points (highest possible score: 32 points) indicated that the patients were satisfied with services provided by this clinic. These results indicate that counseling provided by pharmacists at the outpatient clinic is a valuable way improving subjective symptoms, lung function and medication adherence. These results also indicate that counseling at the asthma clinic by pharmacists improves the quality of life of patients with asthma.     

Outcomes assessment of clinical pharmacy services in a psychiatric inpatient setting.

The effects of psychiatric pharmacy services on clinical outcomes of acute care psychiatric inpatients were studied. Patients recruited at a state psychiatric facility during phase 1 (October 1996-March 1997) served as the control group and received only traditional centralized pharmaceutical services and physician-requested psychiatric pharmacotherapy consultations. Patients recruited during phase 2 (May-December 1997) received intensive psychiatric pharmacy services and served as the experimental group. Pharmaceutical services during phase 2 included attending treatment team meetings, performing baseline assessments and weekly reviews, providing pharmacotherapy recommendations, obtaining medication histories, reviewing drug administration records daily, monitoring for adverse drug reactions, conducting medication education classes, and counseling patients before discharge. Outcome variables included clinical response determined with objective rating scales, cost of care, length of stay, adverse events, rate of acceptance of recommendations, patient compliance with the first clinic visit scheduled after discharge, quality of life, and patient satisfaction. Data were analyzed for 48 patients in the control group and 45 patients in the experimental group. There were no significant differences between the two groups with respect to age, sex, duration of illness, number of hospitalizations, and number of months since the last hospitalization. Patients in the experimental group showed significant improvements in clinical response and drug-induced extrapyramidal symptoms compared with the controls and were highly satisfied with the pharmaceutical services they received. Medication costs did not differ significantly, and length of stay was about 29 days for each group. The provision of clinical pharmacy services provided to inpatients in an acute care psychiatric facility was associated with improvements in rating-scale scores for clinical response and for drug-induced extrapyramidal symptoms.     

我院门诊药房开展药学服务的方法探讨

目的:探讨我院门诊药房开展药学服务的必要性及方法。方法:通过文献调研并结合我院特色,分析开展门诊药学服务的必要性及方法。结果与结论:门诊药房开展药学服务可降低药品费用,提高患者的用药依从性,促进用药安全,缓解医患关系。我院门诊药房可从就诊患者特点考虑用药教育通俗化、借鉴敞开式药房经验、提供电子化药学服务、丰富药学服务内容等方面开展药学服务。     

医院门诊药房患者用药教育的实施探讨

目的:探讨医院门诊药房如何开展有效的患者用药教育。方法:分析医院门诊药房实施患者用药教育的必要性,并设计具体方式。结果与结论:医院门诊药房可通过完善用药咨询体系、发放特定药品时附标示单、建立用药查询及处方提示系统等途径实施有效的患者用药教育,以促进合理用药。     

我院门诊药物咨询分析与体会

目的：对我院药物咨询内容进行分析与总结,发现问题和规律,提高药物咨询服务质量,促进医院药学工作的发展。方法：选取我院2008年5月～2009年5月的310例记录完整的门诊咨询记录进行比较分析,用医学和药学以及相关学科知识,指导患者安全、有效、经济、适宜用药,减少药品不良反应的发生。结果与结论：从我院开设＂药物咨询窗口＂实践中,我们体会到深入浅出地向患者介绍药物的一般知识,可以增加患者对药师的信任和依赖,提高患者用药的依从性,最大限度地提高药物的治疗作用,降低药物的不良反应。     

探析医院药房管理中存在的问题及其改进措施

目的：探讨医院药房管理中存在的问题及其改进措施。方法本次观察组共选择1000份患者用药资料,均为2013年1～10月在我院药房收集,以针对药房管理中存在的问题进行分析,并制定相应改进措施,并就其管理结果与2012年1～12月采用常规药房管理的对照组1000份患者资料进行对比,总结用药安全性及医疗纠纷发生率。结果观察组有效用药率、安全用药率、患者用药依从率评分均高于对照组,医疗纠纷发生率低于对照组,差异均有统计学意义（P＜0.05）。结论针对医院药房管理中存在的问题进行分析,并制定相应的改进措施,可保障用药安全性和有效性,提高患者依从性,避免医疗纠纷的发生,推动医院药房工作和谐发展。     

医院药房药学服务纠纷与预防措施

以药学人员的服务态度、工作状态和合理用药等为依据,分析医院药房进行药学服务时出现的纠纷问题并提出相应的预防措施,以开展优质药学服务,提升医院药房业务水平。在药学服务过程中,减少工作失误、避免不合理用药和提高服务态度,可以明显改善医患关系。药学人员必须具有＂以患者为中心＂的服务理念,才能保障用药安全和患者的就医质量,同时得到患者的认可和避免发生医疗纠纷。     

临床药学实例分析及探讨

目的通过临床药学实例分析,以促进临床合理用药。方法加强处方审核,开展处方点评、用药咨询服务,监测收集药品不良反应,参与会诊,开展药学监护、书写药历等药学服务。结果不合理用药情况有所降低。结论临床药学是医院药学的核心工作,是世界药学发展的趋势。通过参与临床药学工作促进合理用药,保障用药安全、有效。     

Iatrogenic clozapine intoxication after hospital admission: A case-based rationale for an inpatient pharmacy clozapine monitoring service

BackgroundClozapine must be retitrated after 2 consecutive days or more of missed doses owing to the risk of severe hypotension, bradycardia, and cardiac arrest. However, other important adverse events such as somnolence, sialorrhea, or respiratory depression can occur without severe cardiovascular sequalae. These other unintended consequences are not well characterized in the literature. Three cases are reported, highlighting the concerns for continuing clozapine without retitration after periods of not taking the medication. Implications are discussed as well as how pharmacists can collaborate with other disciplines to mitigate safety risks associated with clozapine for hospitalized patients.Case summariesThe first case highlights the importance of medication reconciliation and verifying adherence before clozapine continuation in the hospital. Waiting for collateral information and missing one dose are safer than unknowingly resuming clozapine. The second case suggests that it may be safer to consider patients with unexplained worsening psychiatric symptoms as nonadherent and even partially reduced clozapine doses after nonadherence may be unsafe. The final case demonstrates the importance assessing comedications (e.g., warfarin, phenytoin) that have available therapeutic drug monitoring to suggest nonadherence. Each case resulted in significant adverse events requiring transfer to a higher level of care or prolonged hospitalization.Practice implicationsContinuation of psychiatric medications when a patient is admitted to the hospital is important to prevent worsening of symptoms. However, assessment of clozapine adherence and confidence in that assessment is crucial to prevent clozapine intoxication, severe hypotension, and even death. Pharmacists are uniquely positioned to assess clozapine adherence and ensure patient safety. A hospital-based service was created at a 2000-bed academic medical center to improve transitions of care when patients are admitted with clozapine. The process was created in collaboration with the psychiatric consultation service. Through this process, pharmacists also complete appropriate hematologic monitoring and ongoing clinical monitoring for adverse events.     

住院药房药学服务满意度调查与分析

目的:为满足解放军总医院第五医学中心(以下简称“我院”)住院药房实际工作的需要,优化药学部药学服务质量,提高药学服务满意度。方法:采取随机抽样的方法,收集我院28个临床科室工作人员关于药学服务满意度的调查问卷。采用利克特量表,设置态度分值,通过Microsoft Excel软件对评分进行统计分析。结果:收集有效问卷226份,满意度平均得分>4.3分;病区对住院药房的药学服务基本满意,用药咨询评分最低,仅为(4.38±0.49)分,发药准确度[(4.44±0.89)分]和有效沟通[(4.84±0.39)分]方面有待提高。结论:我院各科室对住院药房的药学服务基本满意,问题主要体现在用药咨询和发药准确度等方面,整体药学服务质量还有一定的上升空间。     

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.     

临床药学与护理服务结合模式的实践研究

目的:探索临床药学与护理服务相结合的成熟工作模式和完善的工作体系。方法:总结本院临床药师与护理工作者工作内容相结合的经验和成果。结果:临床药师在护理医疗工作中开展了合理用药教育、患者用药教育、药物使用技能培训、药物管理知识培训,提升了护理工作者在安全用药中的能力,使患者获得了更多的安全保障和高质量的医疗服务。结论:临床药师进入护理服务领域能更好地确保医疗安全,提高护理质量,减少药物不良事件。     

Clinical pharmacists as allied health care providers to psychiatric patients

The effect of clinical pharmacy services on the quality and economy of health care provided to psychiatric patients at a Veterans Administration outpatient clinic was evaluated. Twenty-one patients were selected from the Day Treatment Center, of these, 19 patients completed the study. In providing health care to these psychiatric patients, the clinical pharmacist used a systemized approach including data gathering, evaluation, plan of action, and follow-up. In addition, medication groups and weekly staff meetings were incorporated into the patient treatment plan. Following a 3-month study period, the impact of clinical pharmacy services was evaluated. The provision of allied health care to psychiatric patients by clinical pharmacists resulted in a decreased incidence and severity of adverse drug effects, fewer drug use problems, a reduction in the total number of drugs prescribed, improved patient drug knowledge, and reduced expenditures for health care without compromising the patient's mental functioning.     

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...     

183例儿科用药电话咨询回顾性分析

目的:调查我院2015年儿科用药电话咨询情况,分析总结工作中存在的问题,为患儿家属提供有针对性的药学咨询服务。方法:对我院2015年1月1日至2015年12月31日儿科用药电话咨询情况进行整理、分析。结果:儿科用药电话咨询记录中,咨询药物以呼吸系统药物和抗菌药物为主,咨询内容以药品用法用量、药物相互作用、误服药物、药物不良反应为主。结论:电话药物咨询可为患儿家属及时提供方便快捷的药学服务,能提高儿童用药的安全性、依从性,提高儿科药学服务质量。     

Evidence-based core clinical pharmacy services in United States hospitals in 2020: services and staffing

We developed a model for the provision of clinical pharmacy services in United States hospitals in 2020. Data were obtained from four National Clinical Pharmacy Services database surveys (1989, 1992, 1995, and 1998) and from the American Health-System Association's 2000 Abridged Guide to the Health Care Field. Staffing data from 1998 indicated that 45,734 pharmacist and 43,836 pharmacy technician full-time equivalent (FTE) staff were employed in U.S. hospitals; 17,325 pharmacist FTEs (38%) were devoted to providing clinical pharmacy services. To provide 14 specific clinical pharmacy services for 100% of U.S. inpatients in 2020, 37,814 new FTEs would be needed. For a more realistic manpower projection, using an evidence-based approach, a set of five core clinical pharmacy services were selected based on favorable associations with major health care outcomes (mortality rate, drug costs, total cost of care, length of hospital stay, and medication errors). The core set of services were drug information, adverse drug reaction management, drug protocol management, medical rounds, and admission drug histories. Implementing these core clinical pharmacy services for 100% of inpatients in 2020 would require 14,508 additional pharmacist FTEs. Based on the current deployment of clinical pharmacists and the services they perform in U.S. hospitals, change is needed to improve health care outcomes and reduce costs. The average U.S. hospital (based on an average daily census of 108.97 +/- 169.45 patients) would need to add a maximum of 3.32 pharmacist FTEs to provide these core clinical services (if they were not provided already by the hospital). Using this evidence-based approach, the five selected core clinical pharmacy services could be provided with only modest increases in clinical pharmacist staffing.     

风险管理在老年精神科干预不良事件管理中的应用

目的:在老年精神科护理中应用风险管理,分析其在不良事件管理的应用效果.方法:选择2020年1月～2020年4月期间某院老年精神科护理出现的不良事件,作为研究组,2019年1月～2019年4月老年精神科护理出现的不良事件作为对照组,共180例患者.比较两组患者出现的不良事件以及干预后心理弹性评分(CD-RISC).结果:...     

Prognostic prediction models and clinical tools based on consensus to support patient prioritization for clinical pharmacy services in hospitals: A scoping review

BackgroundIdentifying patients at high risk of adverse medication-related outcomes for targeted clinical pharmacy services is essential in hospital pharmacy. Models and predictive tools to prioritize patients are available to the clinical pharmacy services for hospital use.ObjectiveTo describe and assess prognostic models and predictive tools used to identify inpatients at risk of adverse medication-related outcomes.MethodsWe searched in Medline, Lilacs, Cochrane, CINAHL, Embase, Scopus and Web of Science, databases of theses and dissertations, and the references of the selected studies. The screening was carried out by two independent researchers. Cross-sectional studies, prospective or retrospective cohort studies, and case-control studies were eligible for inclusion. The studies addressed the development or validation of predictive models and clinical prioritization tools based on expert opinion to identify inpatients at risk of adverse medication-related outcomes.Results25 studies were included, 13 of which were prognostic prediction models, seven were instrument development using the consensus method, and five were validation. The outcome events were drug-related problems (9), adverse drug reactions (8), adverse drug events (6), and medication errors (2). Most studies targeted adult patients (14), eight had older adult patients, one had obstetric patients, and others had pediatric patients. External validation was performed after the development study in three studies. The predictive model with a low risk of bias was the Medicines Optimisation Assessment Tool. Limited details on the method of expert involvement and the number of experts were identified in four studies.ConclusionThe development of patient prioritization tools to optimize pharmacotherapy by clinical pharmacy services is a complex process. The predictive models and tools analyzed are limited in their development and validation process, hindering their effective use in prioritizing patients by the clinical pharmacy services. The development of additional prognostic prediction models for drug-related problems is a priority.     

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,以提高临床药师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,为患儿及其家属提供药学监护和用药宣教,患儿好转出院,随访期间病情未复发。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。     

Pharmaceutical services in U.S. hospitals in 1989.

The results of a spring 1989 national survey of hospital-based pharmacy services are reported. The study group (n = 2112) comprised half of U.S. acute-care general surgical or medical hospitals with 50 or more licensed beds. Pharmacy directors were asked about their hospital's provision of 14 clinical pharmacy services. The survey had a response rate of 56% (1174 usable responses). Provision levels varied significantly with the pharmacy drug delivery system for 14 services, pharmacy director's education for 12 services, hospital teaching affiliation for 12 services, hospital ownership for 9 services, hospital size for 9 services, and geographic region for 5 services. The following percentages of respondents offered specific services: drug-use evaluation, 90%; inservice education, 66%; adverse drug reaction (ADR) management, 46%; drug therapy monitoring, 41%; pharmacokinetic consultations, 40%; parenteral-enteral nutrition team participation, 28%; patient medication counseling, 26%; drug therapy protocol management, 25%; cardiopulmonary resuscitation (CPR) team participation, 25%; clinical research, 22%; drug information, 16%; participation in medical rounds, 13%; poison information, 9%; and medication histories, 2%. Pharmacist staffing requirements for clinical services usually centralized within the department were highest for drug information and poison information. Within hospitals offering the services, four of nine patient-specific services were potentially available to more than half the patients: ADR management, CPR team participation, drug therapy monitoring, and nutrition team participation. Drug therapy protocol management required the most pharmacist staff time. Only one service, pharmacokinetic consultations, was justified by more than half of the providers of that service. Respondents expected all the services to undergo net growth during 1989-90. The 1989 National Clinical Pharmacy Services Survey showed that provision of clinical pharmacy services varied with the pharmacy drug delivery system, pharmacy director's education, hospital teaching affiliation, hospital ownership, hospital size, and geographic region.