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临床药师在慢性肾功能不全患者中的药物重整实践
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| 篇名： | 临床药师在慢性肾功能不全患者中的药物重整实践 |
| TITLE： | |
| 摘要： | 目的：探讨临床药师在药物重整中的作用。方法：选择2015年8－10月收入或转入我院肾病内科的住院患者200例，在入科后48 h内，由临床药师主导，通过查阅电子病历、问诊、查询患者自备药品和既往病史等方式收集其1年内的用药史，并进行药物重整。结果：临床药师获得的药物清单中，药物品种共987种，只有9.63％（95种）的药物在医师的病历中有记录；不良反应共5例，只有40.00％（2例）的不良反应在医师的病历中有记录。200例患者中，有45例患者需进行药物重整，重整率为22.50％；200例患者的492条医嘱中有103条医嘱存在用药偏差，例均用药偏差为（2.3±1.8）个，主要包括用量错误、重复用药、溶剂错误和存在药物相互作用等，其潜在危害等级以1级为主（53条，51.46％）。103条重整医嘱中，重整方案以停药为主（78例，75.73％），其次为改药（17例，16.50％）和加药（8例，7.77％）；共90条重整医嘱被医师采纳，干预成功率为87.38％。结论：与医师相比，临床药师可获得更详细、准确的药物治疗清单。通过临床药师的药物重整，可减少临床用药偏差，最大程度地保证患者用药安全。 |
| ABSTRACT： | OBJCETIVE： To investigate the role of clinical pharmacists in medication reconciliation. METHODS： Totally 200 inpatients admitted or transferred to nephrology department of our hospital during Aug.-Oct. 2015 were selected. Within 48 h after admission， 1-year medication history were collected by reviewing electronic medical records， consultation， querying self-prepared drugs and medical history； and then medication reconciliation was conducted by clinical pharmacists. RESULTS： Among drug lists collected by clinical pharmacists， there were 987 kinds of drugs， but only 9.63％ （95 kinds） drugs were recorded in the medical records. There were 5 cases of ADR in total， and only 40.00％ of them （2 cases） were recorded in the medical records. Among 200 patients， medication reconciliation was needed in 45 cases with reconciliation rate of 22.50％. Among 492 medical orders of 200 patients， medication errors were found in 103 medical orders； the number of medication errors per case was （2.3±1.8）， mainly including wrong dose， repeated medication， wrong solvent， drug interactions； the potential risk degree was mainly degree 1（53 orders， 51.46％）. Among 103 medication reconciliation orders， main plans were drug withdrawal （78 cases， 75.73％）， followed by drug change （17 cases， 16.50％） and drug supplement （8 cases， 7.77％）. A total of 90 reconciled medical orders were adopted by physicians， with success rate of 87.38％. CONCLUSIONS： Compared with physicians， clinical pharmacists can obtain more detailed and accurate drug list. It can reduce medication error and guarantee the safety of drug use to maximum extent that clinical pharmacists conduct medication reconciliation. |
| 期刊： | 2017年第28卷第14期 |
| 作者： | 吴淋淋，张新茹，侯继秋，王冬雪 |
| AUTHORS： | WU Linlin，ZHANG Xinru，HOU Jiqiu，WANG Dongxue |
| 关键字： | 临床药师；慢性肾功能不全；药物重整；药学实践 |
| KEYWORDS： | Clinical pharmacist； Chronic renal insufficiency； Medication reconciliation； Pharmacy practice |
| 阅读数： | 384 次 |
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