老年住院患者实施药物重整服务的实践与分析

Practice and analysis of clinical pharmacists in the implementation of drug integration service for elderly inpatients

目的 总结分析临床药师对老年住院患者的医嘱干预情况,提高我院药学服务质量,促进老年患者合理用药。方法 以我院2020年8月至2021年7月期间老年住院患者为研究对象,临床药师通过药学问诊、查看病历、识别药物不良反应、关注药物相互作用等向医师提出用药重整建议,为患者进行用药教育。结果 共获得药物重整医嘱231例,其中占医嘱比例居前3位药物相关问题分别是遴选药品不适宜(46.32%)、用法用量不适当(34.05%)、药物不良反应(9.87%);居前3位药物重整类别分别为心血管系统类药物(28.14%)、感染性疾病(21.65%)、中枢神经系统药物(14.29%);临床药师药物重整方案以停药(25.97%)、加药(22.51%)、调整剂量(21.21%)为主,医师接受率为87.01%。结论 药师可通过用药重整工作协助医师做好患者的用药服务,促进患者合理用药。

Objective To summarize and analyze the medical advice intervention of clinical pharmacists on elderly inpatients,improve the quality of pharmaceutical care in our hospital,and promote rational drug use in elderly patients.Methods The elderly inpatients in our hospital from August 2020 to July 2021 were selected as the study subjects.Clinical pharmacists proposed medication reform suggestions to physicians through pharmaceutical consultation,medical records,identification of adverse drug reactions,and attention to drug interactions,and provided medication education for patients.Results A total of 231 cases of drug restructuring were obtained,among which the top 3 drug related problems were inappropriate selection of drugs(46.32%),inappropriate usage and dosage(34.05%)and adverse drug reactions(9.87%).The top 3 drug reforming categories were cardiovascular system drugs(28.14%),infectious diseases(21.65%)and central nervous system drugs(14.29%).Clinical pharmacists'drug restructuring programs were mainly drug withdrawal(25.97%),drug addition(22.51%)and dose adjustment(21.21%),and the acceptance rate of physicians was 87.01%.Conclusion Pharmacists can assist physicians to provide medication service for patients and promote rational drug use by medication restructuring.