临床药师在慢性肾功能不全患者中的药物重整实践

发布时间：2018-11-16 18:19

【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]:Objective: to explore the role of clinical pharmacists in drug reorganization. Methods: 200 inpatients who received or transferred to the Department of Nephrology in our hospital from August to October 2015 were selected. Within 48 hours after entering the department, the clinical pharmacists led the patients and consulted the electronic medical records. The history of drug use within 1 year was collected by querying the patient's own medicine and past medical history, and the drug was reorganized. Results: of the 987 kinds of drugs obtained by clinical pharmacists, only 9.63% (95 kinds) were recorded in the physician's medical records. Only 40.00% (2 cases) of the adverse reactions were recorded in the physician's medical records. Of the 200 patients, 45 patients needed to undergo drug reorganization, and the reorganization rate was 22.50%. Of the 492 medical orders of 200 patients, 103 had drug deviation (2.3 卤1.8), which mainly included dosage error, repeated use, solvent error and drug interaction. The potential hazard grade was mainly grade 1 (53 cases, 51.46%). Among 103 orders, 78 cases were stopped (75.73%), 17 cases were modified (16.50%), and 8 cases (7.77%) were added. A total of 90 revamping orders were adopted by doctors, and the successful rate of intervention was 87.38%. Conclusion: clinical pharmacists can obtain a more detailed and accurate list of drug treatments than physicians. The deviation of clinical drug use can be reduced and the safety of patients can be guaranteed by the drug reorganization of clinical pharmacists.
【作者单位】：吉林大学第二医院肾病内科;吉林大学第二医院药品管理部;
【分类号】：R692.5

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