肿瘤科临床药师药学服务常见问题分析

目的探讨肿瘤患者药物使用的安全、有效、经济性，为临床治疗提供药学保障。方法总结2640例次出院肿瘤患者病历资料，将肿瘤临床药师参与药物治疗学相关问题分为医师问题、护理问题及患者用药教育问题，并对其进行回顾性分析。结果需要临床药师解决的肿瘤用药问题比例为20．4％（539／2640）。在539例次药师处置问题中，医师问题占55．1％（297例次），其中药物不良反应、药物选择、联合用药和给药顺序所占比例分别为35．0％（104例次）、30．0％（89例次）、21．9％（65例次）和13．1％（39例次）；护理问题占29．9％（161例次），其中配制浓度、配伍及输注时间占52．8％（85例次），配置后稳定性占34．2％（55例次）；患者用药教育问题占15．0％（81例次）。结论临床药师需要针对临床医师、护士、患者多层次提供药学技术服务，保证药物使用的安全、有效、经济。

Oncology pharmaceutical care practice

Objective To ensure safe, effective and economic drug use for tumor patients. Methods To- tally 2640 cases of tumor patients discharged medical records from January 2011 to January 2013 were analyzed. 539 cases of medication therapeutic problems participated by clinical oncology pharmacist were recorded. Results The cases of clinical pharmacist involved in disposal accounted for 20.4% （ 539/2640 ）. Physician issues accounted for 55.1% （ 297/539 ）. The drug choice in the special case and adverse drug reaction accounted for a significant proportion. Care issues accounted for 29.9% （161/539）. Concentration, compatibility and infusion time totally accounted for 52. 8% （ 85/161 ）. Pharmaceutical care of patient＇ s medication accounted for 15. 0% （ 81/539 ）. Conclusion Clinical pharmacists need to provide professional pharmacy service for clinicians, nurses and patients to ensure the safe effective and economic drug use.