临床药师开展心血管内科入院患者药物重整的实践  

Practice of clinical pharmacist developing in medication reconciliation for the inpatients in cardiovascular medicine department

作　　者：符方方[1] 周国波 林聪茹 高文娟 周鹏飞 廖朝峰[3] FU Fangfang;ZHOU Guobo;LIN Congru;GAO Wenjuan;ZHOU Pengfei;LIAO Chaofeng(Dept.of Pharmacy,Shiyan People’s Hospital of Shenzhen Bao’an District,Guangdong Shenzhen 518108,China;School of Basic Medical Science,Guangdong Medical University,Guangdong Dongguan 523808,China;Dept.of Pharmacy,Shenzhen Bao’an District People’s Hospital,Guangdong Shenzhen 518100,China)

机构地区：[1]深圳市宝安区石岩人民医院药剂科,广东深圳518108 [2]广东医科大学基础医学院,广东东莞523808 [3]深圳市宝安区人民医院药剂科,广东深圳518100

出　　处：《中国药房》2022年第10期1263-1268,共6页China Pharmacy

基　　金：广东省基础与应用基础研究基金项目(No.2021A15-15012583);深圳市宝安区科技计划基础研究项目(No.2020JD405)。

摘　　要：目的分析心血管内科患者入院时的药物重整情况,为心血管内科临床药师工作模式的建立提供参考,也为临床药师与社区药师在患者下转至社区健康服务中心后进行长期的药学监护提供依据。方法选择2020年10月-2021年9月深圳市宝安区石岩人民医院心血管内科新收入或新转入的慢性病住院患者,通过药学问诊对其进行药物重整,根据欧洲药学监护联盟分类系统V9.1对存在的药物相关问题(DRPs)进行分类汇总,并实施有效性、安全性评估,用药宣教等措施,同时对干预接受情况进行分析。结果共纳入了100例患者,男性54例、女性46例,平均年龄(60.21±9.69)岁,平均共患慢性病(2.84±0.83)种,服用药物的中位数量为5.00种。其中,有74例患者累计存在110个治疗药物偏差,涉及10个类别61种药物,累计药物偏差数排名前3位的药物分别为心血管系统药物(35个)、消化系统药物(16个)、内分泌系统药物(15个);上述治疗药物偏差可能造成122个DRPs,以“治疗有效性”问题为主(74个),其发生原因以“患者服药时间或服药间隔时间不适当”最多(32个),其次为“不适当的联合用药”(10个)。临床药师的干预主要集中在患者层面(67个)、药物层面(58个)、医生层面(58个),其中有155个干预(84.70%)被接受并执行。结论部分患者遵医嘱用药意识淡薄,临床药师在入院时主导的药物重整能全面了解患者潜在的用药问题,可协助医生提高其用药依从性、保障其用药安全。OBJECTIVE To analyze the medication reconciliation for the inpatients in cardiovascular medicine department,to provide reference for the establishment of working mode of clinical pharmacists in the department of cardiovascular medicine and to provide a basis for clinical pharmacists and community pharmacists developing pharmaceutical care for patients after transfering to community health center.METHODS From October 2020 to September 2021,newly admitted or newly transferred inpatients with chronic disease were selected from Shiyan People’s Hospital of Shenzhen Bao’an District.Medication reconciliation was conducted by clinical pharmacists after pharmaceutical consultation.According to the Pharmaceutical Care Network Europe(PCNE)classification system V9.1,the existing drug-related problems(DRPs)were classified and summarized.The effectiveness and safety evaluation,medication education and other measures were provided,and the acceptance of intervention was analyzed at the same time.RESULTS A total of 100 patients were included,including 54 males and 46 females.The average age was(60.21±9.69)years,the average number of chronic diseases was(2.84±0.83),and the median number of drugs was 5.00.Among them,110 treatment drug deviations were found in 74 patients,involving 10 categories and 61 drugs.Top three drugs in the list of accumulative drug deviation were cardiovascular system drugs(35 deviations),digestive medicine drugs(16 deviations)and endocrine system drugs(15 deviations).The above treatment drug deviation may cause 122 DRPs,mainly“treatment effectiveness”problems(74 DRPs),and the causes were“inappropriate medication time ormedication interval”(32 DRPs),followed by“inappropriate drug combination”(10 DRPs).Interventions to DRPs mainly concentrated on patient level(67),drug level(58)and doctor level(58),155 of which(84.70%)were fully accepted and implemented.CONCLUSIONS Some patients have a weak awareness of medications according to doctor’s advice;drug reconciliation led by clinical pharmacist

关 键 词：药物重整 临床药师 心血管内科 合理用药 慢性病 

分 类 号：R969.3[医药卫生—药理学] R541[医药卫生—药学]