临床药师在心内科开展临床药学工作参与医嘱审核的干预效果

Intervention Effect of Clinical Pharmacists in Clinical Pharmacy Work and Medical Advice Review in the Department of Cardiology

目的:探讨临床药师在心内科开展临床药学工作参与医嘱审核的干预效果。方法:选取2013年3月至2017年11月内蒙古包钢医院心内科收治的患者3 360例,对其医嘱进行回顾分析。实施临床药师参与医嘱审核干预后收治的1 680例为观察组,另1 680例为对照组。选择资深临床药师、医师成立复核小组,比较2组医嘱不合理情况(药物数量、剂量、配伍等),并对医嘱干预被采纳情况进行分析。结果:对照组医嘱合格1 320例(78.57%),不合格360例(21.43%);观察组干预前合格1 330例(79.17%),不合格350例(20.83%);差异有统计学意义(P>0.05)。临床药师干预后,290例(82.86%)干预被采纳,合格率96.43%,差异有统计学意义(P<0.05)。其中314例(89.71%)为药物不合理问题。降压药、治疗冠心病类药物干预次数最多,分别为86次、52次,降糖药、治疗心功能不全类药物干预效果最好,采纳率分别为42/44(95.45%)、38/40(95.00%)。药物不合理问题以漏服92/314(29.30%)、剂量不当87/314(27.71%)、服药方法不当68/314(21.66%)较为突出,煎法不当53/314(16.88%)和配伍不当14/314(4.46%)发生情况较少。结论:临床药师在心内科开展临床药学工作参与医嘱审核的干预效果较佳,能够有效提高用药合理率,临床高血压、心功能不全药物问题较为突出,可加强对此类药物的干预以提高用药合理性。

Objective： To analyze the effect of clinical pharmacists in the intervention of physician pharmacists in clinical pharmacy work.Methods： A total of 3360 patients admitted to the Department of Cardiology in our hospital from March 2013 to November2017 were selected and their physician orders were reviewed.Among the 1680 patients who received clinical pharmacists＇ participation in the medical examination and intervention,1680 were study groups,and 1680 were control groups.A selection of experienced clinical pharmacists and several doctors formed a review team to compare the unreasonable conditions of the two groups of doctors（ drug quantity,dose,compatibility,etc.）,and analyze the adoption of the doctor＇s intervention.Results： In the control group,1320 cases（ 78.57%） were qualified,and 360 cases（ 21.43%） were unqualified; 1330 cases（ 79.17%） passed the intervention before the study group,and 350 cases（ 20.83%） failed（ P〉0.05）.After the intervention of clinical pharmacists,290（ 82.86%） interventions were adopted and the pass rate was 96.43%（ P〈0.05）.Of these,314 cases（ 89.71%） were unreasonable.Antihypertensive drugs and coronary heart disease drugs had the largest number of interventions,with 86 and 52 interventions respectively.Hypoglycemic drugs and cardiac insufficiency drugs had the best intervention effects.Adoption rates were42/44（ 95.45%） and 38/40（ 95.00%）.The drug irrational problem was mainly caused by missed dose 92/314（ 29.30%）,inappropriate dose 87/314（ 27.71%）,improper medication method 68/314（ 21.66%）,improper cooking method 53/314（ 16.88%） and compatibility.Improper 14/314（ 4.46%） occurred less frequently.Conclusion： The clinical pharmacists in our hospital have better intervention in the clinical pharmacy work and participate in the examination of medical advice.They can effectively increase the rational rate of medication,and the clinical problems of hypertension and cardiac insufficiency are more prominent.The intervention of these drugs can be strengthened to improve medication rationality.