抗凝专业临床药师工作模式及临床实践

Working mode and clinical practice of anticoagulant clinical pharmacists

目的:探索临床药师实施抗凝工作的切入点。方法:借鉴国内外先进管理模式,结合北京大学第一医院具体情况,在如下方面开展了相关工作:1院内抗凝患者的教育管理;2药物基因组学方法指导下进行的药物剂量建议;3医护药师联合的随访门诊;为药师参与的抗凝一体化门诊的建立提供工作模式参考。结果:已经初步取得临床的认可,目前完成抗凝相关患者教育和药物基因组学指导下的药物剂量建议会诊120余例。为进一步建立抗凝的全程化药学服务提供了参考资料。结论:抗凝专业临床药师的介入可以为全面抗凝临床药学服务提供新的模式。

Objective： To explore a working mode of anticoagulant clinical pharmacists. Methods： Following global advanced management mode, combined with situation of our hospital, relative work has been conducted in the following areas： ① Inpatient anticoagulant drugs education management; ②Dosing advising of anticoagulant drugs based on pharmacogenetic method; ③Outpatient follow-up clinics executed by physicians, nurses and pharmacists. All the work above explores a working mode for integrated anticoagulant pharmaceutical care. Results： Anticoagulant education and pharmacogenetic dosing advising have been provided to more than 120 cases till now, which has been preliminarily recognized by the clinical physicians and provided references for further establishing integrated pharmaceutical care. Conclusion： The intervention of clinical pharmacist may provide a new mode of integrated clinical pharmaceutical care.