从案例分析看临床药师在住院患者合理用药中的干预作用

The intervention role of clinical pharmacists in rational drug use of inpatients from case analysis

目的通过不合理用药的医嘱分析,进一步提升临床药师在临床合理用药中的干预作用。方法通过结合临床住院患者的HIS病历系统与药学部PASS合理用药软件系统随机抽取2020年第4季度的病历,对抽取病历的病程记录、用药记录与检验指标进行审核,重点审核患者住院期间的治疗方案,对可能存在的问题组织专家进行讨论,搜集不合理医嘱,对存在的问题进行分析讨论,并与临床医师沟通。通过在临床医嘱专项点评的持续开展,结合临床实际案例,对案例中不合理医嘱进行总结与分析。结果医嘱点评结果发现在临床诊疗过程中,常出现的不合理用药有抗菌药物的选用不适宜、辅助用药的无指征使用、联合用药不适宜与合用两种有拮抗作用的药物。结论医嘱专项点评是医疗机构合理用药考核指标之一,临床药师通过长期、持续开展医嘱专项点评能够有效促进临床用药的合理性。

Objective To further improve the intervention role of clinical pharmacists in clinical rational drug use through the analysis of doctor's orders of irrational drug use.Methods By combining the his medical record system of clinical inpatients and the pass rational drug use software system of the Ministry of pharmacy,randomly select the medical records of the fourth quarter of 2020,review the course records,medication records and test indicators of the selected course,focus on the treatment plan of patients during hospitalization,organize experts to discuss the possible problems and collect unreasonable medical orders,analyze and discuss the existing problems and communicate with clinicians.Through the continuous development of special comments on clinical medical orders,combined with the actual clinical cases,this paper summarizes and analyzes the unreasonable medical orders in the cases.Results The results of doctor's order review found that in the process of clinical diagnosis and treatment,the common irrational drug use included inappropriate selection of antibiotics,non indicated use of adjuvant drugs,inappropriate combination and combination of two antagonistic drugs.Conclusion The special comment on doctor's order is one of the evaluation indexes of rational drug use in medical institutions.Through long-term and continuous special comment on doctor's order,clinical pharmacists can effectively promote the rationality of clinical drug use.