临床药师开展内科住院患者入院药物重整的药学服务实践-中国药房

临床药师开展内科住院患者入院药物重整的药学服务实践

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篇名：	临床药师开展内科住院患者入院药物重整的药学服务实践
TITLE：
摘要：	目的：探讨临床药师在慢性疾病患者药物治疗中的重要性和必要性以及开展药物重整（MR）的可行性，为临床药学内科工作模式的建立提供依据。方法：以2016年5－7月于我院呼吸内科住院的患者为研究对象，介绍临床药师在患者入院当日进行详细的药学问诊后，分别对患者的长期用药进行MR的情况。结果：通过临床药师对住院患者用药过程中存在的问题进行分类归整，共获得98例住院患者的入院MR记录，涉及296条药物医嘱，其中存在用药差错96条。参与MR的患者中，依从性好者仅有44例（占44.9％），其他患者均存在部分用药差错，主要表现为用药随意、用法用量不当、担心药物副作用而拒绝用药、因不良反应而停药、特殊疾病未随访导致用药剂量过量或不足、与医师沟通不畅导致用药错误、忘记服药/漏服和过度医疗等。发生用药差错的药物种类以心血管系统药物最常见，其次为呼吸系统药物和内分泌系统药物。结论：临床药师开展入院MR，有利于识别和纠正患者用药差错，避免潜在的用药差错，且有助于疾病控制，可作为内科病区药学服务工作的项目之一。
ABSTRACT：	OBJECTIVE： To explore the importance and necessity of clinical pharmacists in drug therapy for chronic disease patients， the feasibility of developing medication reconciliation （MR）， and to provide reference for establishing the internal medicine working model of clinical pharmacy. METHODS： During May to Jul. 2016， inpatients were selected from respiratory department of our hospital as subjects. After detailed pharmaceutical consultation， clinical pharmacist conducted MR for newly inpatients at the first day in the hospital. RESULTS： Through clinical pharmacists classified and organized the problems of drug use in the inpatients during medication， MR records of 98 inpatients were collected， involving 296 medical orders and 96 items of medication errors. Among MR patients， there were only 44 cases of good compliance （44.9％）； some problems about drug use existed in other cases， including optional medication， improper usage and dosage， fearing of drug side effects and refusing to use drugs， drug withdrawal due to ADR， follow-up failure of special disease leading to excessive or inadequate dose， poor communication with doctors leading to medication errors， forgetting to take medication or missing， excessive medical treatment and so on. Most common medication error-inducing drugs type was cardiovascular drug， followed by respiratory drug and endocrine system drug. CONCLUSIONS： The development of MR by clinical pharmacists is helpful to identify and correct medication error， avoid potential medication error， and control disease. It can be used as a project of pharmaceutical care in department of internal medicine.
期刊：	2017年第28卷第32期
作者：	姚慧娟，李平，刘昕竹，卜书红#，张健
AUTHORS：	YAO Huijuan，LI Ping，LIU Xinzhu，BU Shuhong，ZHANG Jian
关键字：	临床药师；药物重整；呼吸内科；药学服务；用药差错
KEYWORDS：	Clinical pharmacist； Medication reconciliation； Respiration department； Pharmaceutical care； Medication error
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