1例大面积脑梗死患者的药物重整与药学监护
|
摘要
目的通过临床药师参与1例大面积脑梗死患者的治疗实践,探讨在临床治疗过程中临床药师提供以药物重整为基础的药学服务的可行性、有效性。方法临床药师对患者进行入院、出院药物重整、住院期间用药医嘱审核,发现用药问题,提出药物调整建议,与医生共同讨论决定药物治疗方案,对住院患者进行全程的药学监护。结果避免了一些可预防的药品不良事件与用药偏差的发生,经过系统治疗,患者病情好转出院。结论以药物重整为基础的药学服务可优化药物治疗方案,确保患者医疗安全,实现药物治疗的准确性、连续性。
Objective To explore the feasibility and effectiveness of clinical pharmacists providing pharmaceutical care(PC) based on medication reconciliation(MR) in clinical therapy through clinical pharmacists participating in the treatment process of a patient with large hemispheric infarction(LHI). Methods The clinical pharmacists performed MR and checked prescription on patient, and then searched medication errors and provided advice on the medication therapy. In the end pharmacists discussed with the doctors to decide the medication regimens, conducted the whole-process pharmaceutical care for the hospitalized patient. Results Some preventable adverse drug events and medication errors were avoided, and the patient was discharged in good condition after systematic treatment. Conclusion Medication reconciliation-based pharmaceutical care can optimize medication regimens, ensure patients' medical safety, and achieve the accuracy and consistency of medication therapy.
Objective To explore the feasibility and effectiveness of clinical pharmacists providing pharmaceutical care(PC) based on medication reconciliation(MR) in clinical therapy through clinical pharmacists participating in the treatment process of a patient with large hemispheric infarction(LHI). Methods The clinical pharmacists performed MR and checked prescription on patient, and then searched medication errors and provided advice on the medication therapy. In the end pharmacists discussed with the doctors to decide the medication regimens, conducted the whole-process pharmaceutical care for the hospitalized patient. Results Some preventable adverse drug events and medication errors were avoided, and the patient was discharged in good condition after systematic treatment. Conclusion Medication reconciliation-based pharmaceutical care can optimize medication regimens, ensure patients' medical safety, and achieve the accuracy and consistency of medication therapy.
引文
[1] Sen S, Siemianowski L, Murphy M, et al. Implementation of a pharmacy technician-centered medication reconciliation program at an urban teaching medical center[J]. Am J Health Syst Pharm, 2014,71(1):51-56.
[2] Kilcup M, Schultz D, Carlson J, et al. Postdischarge pharmacist medication reconciliation:Impact on readmission rates and financial savings[J]. J Am Pharm Assoc, 2013, 53(1):78-84.
[3] Renaudin P, Boyer L, Esteve M A, et al. Do pharmacistled medication reviews in hospitals help reduce hospital readmissions? A systematic review and meta-analysis[J]. Br J Clin Pharmacol,2016,82(6):1660-1673.
[4] Alex S, Adenew A B, Arundel C, et al. Medication errors despite using electronic health records:the value of a clinical pharmacist service in reducing discharge-related medication eerrors[J]. Qual Manag Health Care, 2016, 25(1):32-37.
[5] Chen C M, Kuo L N, Cheng K J, et al. The effect of medication therapy management service combined with a national PharmaCloud system for polypharmacy patients[J]. Comput Methods Programs Biomed, 2016,134:109-119.
[6]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志, 2015,48(4):246-257.
[7]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志, 2007, 35(4):295-304.
[8] Jauch E C, Saver J L, Adams H P, et al. Guidelines for the Early Management of Patients with Acute Ischemic Stroke:A Guideline for Healthcare Professionals form AHA/ASA[J]. Stroke, 2013,44(3):870-947.
[9]黄珊,林玮玮,宋洪涛.药物重整对内科慢性病患者的作用[J].解放军药学学报, 2017, 33(2):198-199.
[10] Whelton P K, Carey R M, Aronow W S, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APh A/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults:Executive Summary:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J]. Circulation. 2018,138(17):e426-e483.
[11]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J].中华神经科杂志, 2015, 48(4):258-273.
[12]中国脑梗死急性期康复专家共识组.中国脑梗死急性期康复专家共识[J].中华物理医学与康复杂志, 2016, 38(1):1-6.
[13] Pronovost P, Weast B, Schwarz M, et al. Medication reconciliation:A practical tool to reduce the risk of medication errors[J]. J Crit Care, 2003, 18(4):201-205.
[14]刘莹,崔向丽,刘丽宏.国内外药物重整研究进展[J].中国药学杂志, 2015, 50(24):2099-2102.
[15]李娟,张成志,陈庆宪,等. 17个省(区、市)56家“三甲”医院医务人员及患者对临床药师的需求及评价调查[J].中国药房,2018, 29(8):1136-1139.
[2] Kilcup M, Schultz D, Carlson J, et al. Postdischarge pharmacist medication reconciliation:Impact on readmission rates and financial savings[J]. J Am Pharm Assoc, 2013, 53(1):78-84.
[3] Renaudin P, Boyer L, Esteve M A, et al. Do pharmacistled medication reviews in hospitals help reduce hospital readmissions? A systematic review and meta-analysis[J]. Br J Clin Pharmacol,2016,82(6):1660-1673.
[4] Alex S, Adenew A B, Arundel C, et al. Medication errors despite using electronic health records:the value of a clinical pharmacist service in reducing discharge-related medication eerrors[J]. Qual Manag Health Care, 2016, 25(1):32-37.
[5] Chen C M, Kuo L N, Cheng K J, et al. The effect of medication therapy management service combined with a national PharmaCloud system for polypharmacy patients[J]. Comput Methods Programs Biomed, 2016,134:109-119.
[6]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志, 2015,48(4):246-257.
[7]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志, 2007, 35(4):295-304.
[8] Jauch E C, Saver J L, Adams H P, et al. Guidelines for the Early Management of Patients with Acute Ischemic Stroke:A Guideline for Healthcare Professionals form AHA/ASA[J]. Stroke, 2013,44(3):870-947.
[9]黄珊,林玮玮,宋洪涛.药物重整对内科慢性病患者的作用[J].解放军药学学报, 2017, 33(2):198-199.
[10] Whelton P K, Carey R M, Aronow W S, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APh A/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults:Executive Summary:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J]. Circulation. 2018,138(17):e426-e483.
[11]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J].中华神经科杂志, 2015, 48(4):258-273.
[12]中国脑梗死急性期康复专家共识组.中国脑梗死急性期康复专家共识[J].中华物理医学与康复杂志, 2016, 38(1):1-6.
[13] Pronovost P, Weast B, Schwarz M, et al. Medication reconciliation:A practical tool to reduce the risk of medication errors[J]. J Crit Care, 2003, 18(4):201-205.
[14]刘莹,崔向丽,刘丽宏.国内外药物重整研究进展[J].中国药学杂志, 2015, 50(24):2099-2102.
[15]李娟,张成志,陈庆宪,等. 17个省(区、市)56家“三甲”医院医务人员及患者对临床药师的需求及评价调查[J].中国药房,2018, 29(8):1136-1139.