哺乳期用药咨询服务临床思维模式和决策路径的探索与建立  

Exploration and establishment of clinical thinking model and decision‑making pathway for medication consultation service during lactation

作　　者：李慧博[1,2] 赵喆 杨璨羽 程吟楚 刘芳 朱依谆[2] 卢㛃[3] 魏瑗 韩彤妍[4] 赵荣生[1,2] Li Huibo;Zhao Zhe;Yang Canyu;Cheng Yinchu;Liu Fang;Zhu Yizhun;Lu Jie;Wei Yuan;HanTongyan;Zhao Rongsheng(Department of Pharmacy,Peking University Third Hospital,Beijing 100191,China;School of Pharmacy,State Key Laboratory of Quality Research in Chinese Medicine,Macao University of Science and Technology,Macao 999078,China;Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China;Department of Pediatrics,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院药剂科,北京100191 [2]澳门科技大学药学院,澳门科技大学中药质量研究国家重点实验室,中国澳门999078 [3]北京大学第三医院妇产科,北京100191 [4]北京大学第三医院儿科,北京100191

出　　处：《药物不良反应杂志》2023年第11期669-675,共7页Adverse Drug Reactions Journal

基　　金：中国药学会医院药学科研专项(CPA‑Z05‑ZC‑2021‑002)。

摘　　要：目的建立标准化哺乳期用药咨询服务临床思维模式和决策路径,保障哺乳期妇女用药咨询服务的规范化。方法对2020年6月至2022年8月北京大学第三医院临床药师为医务人员提供的哺乳期用药咨询服务情况进行回顾性统计分析和根因分析。应用混合方法建立哺乳期安全用药临床思维模式和哺乳期安全用药路径。对药师进行哺乳期用药咨询服务培训,培训前后进行问卷调查,对改进效果进行评价。结果共收集到临床药师为医务人员提供的用药咨询服务1218例,其中哺乳期用药相关案例44例(3.61%)。研究结果显示,临床药师在开展哺乳期用药咨询服务中存在对患者的需求了解不清晰,药物、母体及婴儿3个方面因素考量不全面,信息检索途径单一等问题。基于存在的问题进行根因分析,建立“提出问题(Q)、评估因素(A)、检索评价(S)和制定方案(P)”(QASP)的哺乳期安全用药临床思维模式,制定安全用药决策分析临床路径并形成标准的用药咨询记录模板。与培训前比较,临床药师在明确哺乳期用药相关因素、循证流程、规范记录和用药咨询自信心等方面均有显著提升(均P<0.001)。结论哺乳期安全用药咨询服务的QASP临床思维模式和基于药物、母体及婴儿3个因素的决策分析模式的建立,有助于临床药师针对哺乳期特殊人群开展标准化用药咨询服务,提高同质化药学服务质量。Objective To explore and establish a standardized clinical thinking mode and decision-making pathway for lactation medication consultation services and ensure the harmonization and safety of medication for lactating women. Methods Lactation medication consultation services for medical staffs conducted by pharmacists from June 2020 to August 2022 in Peking University Third Hospital were analyzed using methods of retrospective statistical analysis and root cause analysis. Application of mixed methods were used to establish a clinical thinking model for medication use during lactation and a clinical pathway for safe medication use during lactation. Lactation medication consultation service training for pharmacists was provided, questionnaire surveys before and after the training were conducted, and the effectiveness of improvement was evaluated. Results A total of 1-218 medication consultation services provided by clinical pharmacists to medical staffs were collected in the hospital, including 44 cases (3.61%) related to lactation medication. Retrospective analysis showed that clinical pharmacists did not have a clear understanding of patients′ needs, incomplete consideration of drug-maternal-infant factors, and a limited way to retrieve information in the lactation medication consultation service. Based on the root cause analysis of the problems, a clinical thinking mode of “Questions (Q), Assessment (A), Search (S), and Plan (P)" (QASP) were established. Additionally, a clinical pathway for safe medication decision-making analysis and a standard medication consultation record template was developed. Compared with before training, clinical pharmacists made significant progress in clarifying factors related to lactation medication, evidence-based procedure, standardized documentation, and confidence in providing medication consulations (all P<0.001). Conclusion The establishment of the QASP clinical thinking model and decision analysis model, based on the 3 factors of medication, mother, and baby for the consul

关 键 词：哺乳期用药 用药咨询服务 混合方法 临床思维模式 临床决策路径 

分 类 号：R95[医药卫生—药学]