临床药师干预肾功能重度不全患者的效果分析

目的 探讨临床药师干预肾功能重度不全患者的效果，为临床药师深入开展临床工作提供参考。方法 审核2016 年1 月~2016 年12月肾功能重度不全患者的住院医嘱，对不合理医嘱提出建议并进行优化。结果 临床药师总共干预243次，成功干预195次，干预总成功率为80.25%；其中调整药物的给药剂量所占比例为54.36%；抗菌药物的干预成功率为90.12%；106例患者经调整药物的给药剂量，日均费用降低约（45.2±10.8）元； 57例患者经更换临床用药，共为患者节省费用3 668.9元。结论 临床药师通过对肾功能不全患者的药物选择和剂量方面进行干预，显著降低了不合理医嘱发生率，在一定程度上改善临床医师的用药习惯，确保了患者的用药安全。

The effectiveness analysis of clinical pharmacists intervention in patients with severe renal insufficiency

Objective Investigating the effect of clinical pharmacists intervention in patients with severe renal insufficiency, to provide reference for clinical pharmacists to carry out clinical work in depth.Methods Review the inpatient order from January 2016 to December 2016 in patients with severe renal insufficiency, give suggestions and optimize the unreasonable medical orders.Results A total of 243 clinical pharmacists intervention carried out and successfully intervened 195 times,with a total success rate of 80.25%,including 54.36% drugs dosage adjusted; The success rate of antibiotic drugs was 90.12%.Through adjusted dose of medication in 106 patients,the average daily cost reduced about (45.2±10.8)RMB;Through replaced the clinical medication of 57 patients,a total cost of 3 668.9 RMB for patients was saved.Conclusion By intervening on drug selection and dosage in patients with renal insufficiency, clinical clinicists can significantly reduce the incidence of unreasonable medical order and improve their medication habits to ensure the medication safety of patients.