老年患者药物重整及药学服务研究  

Research of medication reconciliation and pharmaceutical care in elderly patients

作　　者：于旭红[1] 柳杨[2] 王光辉[3] 张金萍[4] YU Xu-hong;LIU Yang;WANG Guang-hui;ZHANG Jin-ping(Department of Pharmacy,The 305 Hospital of People's Liberation Army Beijing 100017,China;Heart Center Ward Two,The 305 Hospital of People's Liberation Army Beijing 100017,China;Cadre Ward,The 305 Hospital of People's Liberation Army Beijing 100017,China;Department of Medical,The 305 Hospital of People's Liberation Army Beijing 100017,China)

机构地区：[1]中国人民解放军305医院药局,北京100017 [2]中国人民解放军305医院心脏中心二病区,北京100017 [3]中国人民解放军305医院干部病房,北京100017 [4]中国人民解放军305医院院办,北京100017

出　　处：《中国临床药理学杂志》2020年第2期203-205,共3页The Chinese Journal of Clinical Pharmacology

基　　金：中国人民解放军305医院院重点课题基金资助项目(17YZ02)。

摘　　要：目的通过对我院老年患者实施药物重整服务,为老年患者提供安全、有效、经济、合理的用药方案。方法纳入我院干部病房和心脏中心符合入排标准的住院患者,临床药师收集用药史,重整用药清单,出院时给予用药教育。结果在205例患者中,实施药物重整68例,重整医嘱265条。药物重整主要为心血管系统药物和消化系统药物的用法错误,其次为服用药物疗程过长后停药。结论药物重整后保证老年患者用药的安全、有效、合理、经济。Objective To avoid potential medication errors,ensure drug safety and rational,clinical pharmacist provide medication reconciliation service for elderly inpatients.Methods Clinical pharmacist took medication reconciliation service for elderly inpatients from cadres wards and cardiac vascular medicine department of heart center in our hospital.Results We collected 205 patients medical histories and 68 patients medication reconciliations were implemented,the most common problems were irrational uses,espespecially for cardiovascular and digestive-related medicines.Conclusion Medication reconciliations is very important to ensure safety and rational use of medication in elder patients.

关 键 词：药物重整 临床药师 药物不良反应 药物相互作用 

分 类 号：R97[医药卫生—药品]