临床药师对心血管内科388例用药医嘱的干预情况分析

目的 分析临床药师对心血管内科388例用药医嘱的审核干预情况，发现临床药师药学干预的主要特征。方法 提取临床药师对2014年-2015年心血管内科用药医嘱的干预数据，对药学干预患者的基础特征、药学干预用药品种分类情况、药师干预的用药相关问题类型等数据进行统计分析。结果 临床药师干预不合理用药医嘱388例，其中314例干预被医师采纳（采纳率为80.9%），药学干预品种排名前3位的品种分别为心血管系统药物（42.0%）、抗感染药物（16.6%）和消化系统药物（15.3%），根据用药相关问题进行分类，排名前3位的用药相关问题分别为漏服药物（20.7%）、禁忌证（15.3%）和给药剂量不合理（10.2%）。结论 临床药师参与药物治疗及药学服务可以降低用药差错的风险，提高药物的合理应用，保障药物的安全使用。

Analysis of Pharmaceutical Intervention of 388 Cases of Medical Orders in Cardiology

OBJECTIVE To explore the effect of pharmaceutical intervention of 388 medical orders in cardiology, and to reveal the key point in the clinical pharmacists intervention work. METHODS The intervention data of medical orders in 2014-2015 were collected. The patient characteristics, drug classification and types of irrational drug use involved in pharmaceutical intervention were analyzed. RESULTS In 388 medical orders intervented by pharmacist, there were 314 cases accepted by physicians. The most related drug classification was cardiovascular drugs(42.0%), followed by antibiotics(16.6%) and digestive related drugs(15.3%). In the types of irrational drug use intervention, omitting medication occurred most frequently (20.7%), then contraindication(15.3%) and inappropriate dose(10.2%). CONCLUSION Clinical pharmacists involved in drug therapy and pharmacy services could reduce medical errors and improve rational use of drugs to ensure the safe use of the drug.