临床药师参与合理用药管控的药学服务模式及效果分析

摘 要 目的：临床药师参与合理用药管控的药学服务模式的建立。方法: 医院建立合理用药考核及监管体制,制定《医师合理用药记分制管理考核标准》;通过信息化手段对重点监控药品的适应证进行管控,建立质控体系实时动态监测;临床药师针对不合理用药问题进行综合干预。结果:2017年上半年药占比、抗菌药物使用强度、重点监控药品费用、人均药费均呈下降趋势;各项指标均达标;且2017年上半年临床药师会诊数量明显增加。结论:临床药师在合理用药管控模式中发挥了重要作用,有助于合理用药各项指标的达标,促进临床合理用药。     

江苏南通市9家医院临床药学发展现状调查

目的 了解江苏南通市主要医院临床药学工作开展现状,为促进地区医疗卫生机构及国内发展中城市临床药学工作的开展提供参考。方法 采用电子邮件的方式,对南通市9家医院进行临床药学工作开展现状调查,并对有关数据进行分析。结果 76.47%的专职临床药师和20.00%的兼职临床药师经过正规培训取得相应资质;临床药师所进修专业方向排名前4位的分别为抗感染药物、心血管内科、抗肿瘤药物和呼吸内科方向;参与医师查房、医嘱和处方点评、专项点评、抗菌药物专项点评、书写药历、抗菌药物事后干预、药学信息服务、门诊药物咨询、出院带药教育、病区医务人员用药交流以及ADR监测的比例最高,均为100.00%,而参与院外会诊比例最低（为0）;基地医院各项工作开展比例、工作量以及科研成果普遍优于非基地医院。结论 南通市受访医院仍需壮大临床药师队伍,多途径提升药学服务能力,加强临床药师工作深度,提升科研创新实力,并进一步促进非基地医院临床药学发展。     

临床药师参与1例左上肺腺癌伴骨转移患者的止痛用药方案实践

摘 要 目的：探讨临床药师在止痛用药方案中的药学服务作用和药学监护模式。方法: 临床药师通过参与1例左上肺腺癌伴骨转移患者的止痛用药诊疗过程,分析患者治疗过程中止痛药物使用的合理性及相应的药学监护内容。结果: 临床药师在癌痛患者药学监护过程中,及时发现并协助医生解决问题,为临床提供合理性建议。结论:临床药师开展的癌痛患者止痛用药监护,有助于促进癌痛治疗的个体化和规范化,在癌痛合理用药和减少药物不良反应等方面发挥着重要的药学作用。     

临床药师对过敏性紫癜患者的用药干预与监护

摘 要 目的：通过临床药师参与会诊提供药学监护,提高过敏性紫癜患者药物治疗的有效性、安全性,以及患者的用药依从性。方法: 药师在1例过敏性紫癜患者的治疗过程中,结合临床表现提出调整用药方案的建议,并从药品不良反应的监护、相关检验指标的监测等方面提供药学服务。结果: 通过临床药师参与制订用药方案,加强用药的针对性及用药过程的监护,使患者得到有效缓解。结论:临床药师参与过敏性紫癜治疗用药会诊,体现了临床药师以患者为中心的药学服务理念,提高了救治的有效率和安全性。     

医改背景下中国15省市医院药师现状调研

摘 要 目的： 探寻医院药师未来发展方向。方法: 采用现场问卷和邮寄问卷相结合的方法,对全国15省市不同等级医院的药师的工作现状进行调查,基于数据的统计分析,科学研究医院药师工作目前存在的问题。结果: 各级医院人力资源差距较大;药师工作待遇和环境有待提高;继续教育和立法不够规范和统一;临床药学及合理用药工作有待进一步发展。结论:建议建立和健全相关法律法规,保障药师合法权益;完善药师培养体系,提升药师的专业素质,促进医院药学发展。     

浙江省临床药师师资培训实践与体会

目的 介绍浙江省临床药师师资规范化培训模式,为我国临床药师师资培养提供借鉴。方法 参照中华医学会临床药学分会临床药学师资培训的要求,结合浙江省临床药师培养特点,建立临床药师师资的理论培训体系、临床实践规范化培养方案和标准化考核方案。结果 师资培训的成绩总分为400分,包括药学问诊、满意度、理论考核、临床思维考核和作业。此次培训药师总分最高为382分,平均分为340.3分。培训前后,药师的成绩平均提高24.09分。结论 浙江省的临床药师师资规范化培训模式充分培养了临床药师师资主动带教能力,具有较强的操作性和规范性,值得借鉴和学习。     

贵州省医疗卫生机构临床药学工作现状调查

摘 要 目的：了解贵州省医疗卫生机构开展临床药学工作的开展现状。方法: 采用问卷调查形式对贵州省108家医疗卫生机构药师进行现场问卷调查,并对结果进行统计分析。结果: 共收回问卷246份,含二级以上医疗卫生机构的有效问卷231份。参会药师大多来自二级医院,开展临床药学工作的主要内容和比例分别为: 药师参与临床查房47.11%;参与临床会诊16.65%; 参与实习带教38.84%; 参与处方点评72.73%; 抗菌药物监测62.37%; 用药咨询与教育58.68%; 药品不良反应监测77.32%。结论:贵州省临床药学整体发展滞后,临床药师数量不足,不能满足临床日益增加的个体化用药需求。贵州省药师群体对待该学科的认识度有所提高,但是总体上优秀人才匮乏,导致临床药学工作无法深入开展。     

基于JCI国际医院认证理念探讨临床药学监护报告纳入医院病案管理的意义

目的：用国际联合委员会（JCI）国际医院认证理念,探讨临床药学监护报告纳入医院病案管理的意义。方法：通过JCI国际医院认证基本理念,阐述了临床药师药历是临床药师分析、评估病人用药的原始医疗文件,其核心是药学监护报告。通过临床实例说明药学监护报告在病人安全、合理、有效、经济用药过程中的重要性,进而提出药学监护报告纳入医院病案管理的意义。结果：药学监护工作是临床工作重要的组成部分,药历及其监护报告是重要的医疗文件,应当纳入医院病案管理范畴。结论：药学监护报告纳入医院病案管理对于规范医生与临床药师交流、提高病人用药质量具有重要作用。     

临床药师参与1例卵巢癌并肝硬化治疗体会

摘 要 目的：临床药师参与临床治疗,以促进肿瘤并肝硬化患者用药的安全性、合理性和有效性。方法: 介绍临床药师参与1例卵巢癌并肝硬化患者的治疗过程,通过查阅相关指南和国内外文献,发挥自身药学特长,为患者提供合理的个体化用药方案。结果: 通过临床药师参与制定治疗方案,可提高患者的治疗效果,避免这类患者潜在的治疗风险,保证用药安全性。结论:通过临床药师参与临床治疗,促进了用药的规范化,并为临床治疗类似病人提供一种思路和方法。     

临床药师参与1例骶骨恶性神经鞘瘤患者神经病理性疼痛的治疗体会

摘 要 目的：临床药师参与临床治疗,促进肿瘤患者用药的安全性和有效性。方法: 介绍临床药师参与1例骶骨恶性神经鞘瘤患者神经病理性疼痛的治疗过程,通过查阅相关指南和国内外文献,发挥药学专业特长,为患者提供合理的个体化用药方案。结果: 临床药师根据患者疼痛性质与程度,调整阿片类、非阿片类药物的种类和剂量,有效地控制疼痛,使NRS疼痛评分控制在1～2。保证疗效的同时减轻不良反应,保证持续的药物治疗。结论: 临床药师参与临床治疗,促进了用药的规范化,并为临床治疗类似患者提供一种思路和方法。     

临床药师绩效考核制度的构建

目的 建立新医改背景下医院临床药师的绩效考核制度,激励和挖掘临床药师潜能,强化竞争与责任意识,提高临床药学工作成绩。方法 以工作量为核心,创新性、效益性、推广性工作为导向,工作质量、时效性和成果并重的原则,制定考核制度与明细。结果 结合临床药学实际情况,制定了覆盖日常工作、牵头工作、科研服务、工作态度、对外交流与学术辐射、教学工作、临床问题挖掘与创新性工作、科研成果、学术任职与个人荣誉、医德医风的临床药师工作量化方案,并建立了科学可行的考核方法、分值细则和计算方法。结论 本研究建立的临床药师考核制度客观可行,达到了临床药师的绩效考核目的,对提高临床药学管理水平和药学服务质量均具有重大意义。     

以“合作社”模式促进基层医院临床药学的发展

目的 探讨促进基层医院临床药学发展的"合作社"模式。方法 通过调研基层医院合理用药的现状及需求,结合基层医院临床药学发展现状,探索以更切合实际的、更能在医师层面推广的合理用药管控以及临床药学发展模式。结果和结论 基层医院存在的用药问题不比省、市级医院少,而且相对来说医务人员的合理用药观念和水平都较低,药剂人员的学历和知识水平也较低,临床药学的开展起步晚、层次低、人员少。通过几家医院组成"临床药师合作社"的模式,可以实现临床药师资源共享,互相学习、互相帮助、互相促进,不仅很好地提高了自身的业务水平,改变医院管理层对临床药学的认识,而且迅速提高了临床合理用药水平,使临床药师、临床药学在医院里得到充分的认可。     

Hospital clinical pharmacy services in Vietnam

Background Clinical pharmacy is key to the quality use of medicines. While there are different approaches in different countries, international perspectives may inform health service development. The Vietnamese Ministry of Health introduced a legal regulation of clinical pharmacy services in December 2012. Objective To describe the services, and to explore reported barriers and facilitators in implementing clinical pharmacy activities in Vietnamese hospitals after the introduction of Vietnamese Ministry of Health legal regulation. Setting Thirty-nine hospitals in Hanoi, Vietnam, including 22 provincial and 17 district hospitals. Method A mixed methods study was utilized. An online questionnaire was sent to the hospitals. In-depth interviews were conducted with pairs of nominated pharmacists at ten of these hospitals. The questionnaire focused on four areas: facilities, workforce, policies and clinical pharmacy activities. Main outcome measure Proportion of clinical pharmacy activities in hospitals. Themes in clinical pharmacy practice. Results 34/39 (87%) hospitals had established clinical pharmacy teams. Most activities were non-patient-specific (87%) while the preliminary patient-specific clinical pharmacy services were available in only 8/39 hospitals (21%). The most common non-patient-specific activities were providing medicines information (97%), reporting adverse drug reactions (97%), monitoring medication usage (97%). The patient specific activities varied widely between hospitals and were ad hoc. The main challenges reported were: lack of workforce and qualified clinical pharmacists. Conclusion While most hospitals had hospital-based pharmacy activities, the direct patient care was limited. Training, education and an expanded work forces are needed to improve clinical pharmacy services.

     

四川省临床药学培养模式及认知现状调研

目的：为改进临床药学人才培养模式提出建议。方法：采用调查研究法,对四川省部分医院的临床药学利益相关方和四川省开设了临床药学专业（或方向）的高校进行问卷调查。结果：共发出问卷511份,收回有效问卷495份,有效回收率为96.87%。调查显示,临床药师的工作得到了医疗团队成员的肯定。大部分临床药师或在读的临床药学专业学生对目前的知识结构和培养方案表示认可,但仍认为应加强临床药学实践以及相关交叉学科知识的学习;现行的学科体系基本可以满足需求,只是在实践与理论教学比重、学科交叉、部分课程设置、教师资源整合上有待完善。结论：①应制定准则,促进临床药学工作的规范化发展;②合理调整专业课程内容,有效进行学科交叉;③设置统一的课程标准,进行专业认证标准分层;④设置长学制临床药学本硕连读专业,增加实践课程比例;⑤整合师资力量,充分发挥医院临床药师的潜能。     

Opportunities and responsibilities for pharmacists on short-term medical mission teams

BackgroundAmerican medical mission teams commonly travel to developing countries for short-term provision of clinical services. Although medications play an important role in the work of these teams, how to plan and organize a mission field pharmacy has been seldom described in the literature.ObjectiveTo describe pharmacist participation in medical mission work.SummaryGlobal standards and policies, as well as traditional best practices, should be applied to the selection, acquisition, use, and disposition of medications taken into a host country. This report describes the roles and responsibilities of pharmacists in planning and organizing a mission pharmacy and in delivering quality pharmacy services in the field.ConclusionPharmacists have an important contribution to make to medical mission teams. Pharmacist knowledge of drug products, regulatory issues, medication storage, dispensing, patient consultation, therapeutic substitution, and pharmacy organization and workflow is ideally suited for mission field work.     

Fighting against COVID-19: Innovative strategies for clinical pharmacists

BackgroundClinical pharmacists’ routine task is carrying out pharmaceutical care to ensure patients' safe and reasonable medication use. However, under public health emergencies, such as the outbreak of COVID-19, the work strategies of clinical pharmacists need to be modified according to the rapid spread of the disease, where information and resources are usually lack to guide them.ObjectiveTo retrieve and investigate the prevention and control measures of clinical pharmacists during the outbreak of novel coronavirus, summarize the roles and responsibilities of clinical pharmacists, and to propose innovative strategies for developing pharmacy services under the epidemic.MethodsThe Chinese and English databases, self-media network, website of professional society or medical institution, and clinical trial center platforms were searched, and clinical pharmacists involved in the work against COVID-19 were surveyed and interviewed. Investigate the challenges and needs of frontline medical staffs for treating patients, and formulate strategies based on the actual medical environment.ResultsClinical pharmacists play a vital role in leading the industry to formulate work instructions, provide frontline medical staff with drug information, and develop innovative pharmacy services to promote the rational use of medicines with collaborative teamwork and close communication according to the epidemic situation of COVID-19. Anti-epidemic work indeed has driven the development of remote pharmacy services.ConclusionFacing public health emergencies, clinical pharmacists can give full play to their professional expertise, analyze the current situation rationally, formulate telehealth strategies swiftly, and work in a united and efficient manner to provide innovative pharmacy services to ensure medication safety and rational use of medicine.     

Clinical and conventional pharmacy services in Polish hospitals: a national survey

Background Pharmacist-led care services within the hospital pharmacy setting have a significant impact on efficient drug management processes. The work of pharmacists is directly associated with the provision of drugs and medical supplies along with additional clinical, administrative, organizational and educational duties. Depending on the country, these practice roles may differ to a significant extent. Objective The aim of this research was to explore the role of the hospital pharmacist and the provision of both clinical and traditional pharmaceutical services for patients and medical staff in Polish general hospitals. Setting Hospital pharmacies from all general hospitals in Poland. Method A cross-sectional study was conducted, utilizing an anonymous questionnaire as the research instrument. Heads of hospital pharmacies were requested to participate in this study and complete the questionnaire. The survey was initially piloted to improve the research method. Main outcome measure The types of pharmaceutical services performed in Polish general hospitals. Results 166 hospital pharmacies took part in this survey. The overall response rate was 60.8 %. The total number of full-time equivalent (FTE) professionals employed within the surveyed hospital pharmacies was approximately 833. The procurement and distribution of drugs were identified as pharmaceutical services performed by most of the participants. The significant majority of pharmacists were also involved in compounding, adverse drug reaction monitoring and rational drug management services. Eleven (7 %) of the responding pharmacists had direct contact with patients and 7 (4 %) pharmacists took part in ward rounds. More precise legal regulations regarding hospital pharmacy practice were measures indicated by most pharmacists as necessary changes required in the hospital pharmacy system. Conclusion Polish hospital pharmacists provide various pharmaceutical services. Their work is closely related with direct provision of drugs. There is an observed inadequate level of clinical services provided in comparison to clinical settings in other countries.