老年科住院患者药物重整中药师的作用

The value of pharmacist in medication reconciliation focusing on inpatients in the division of geriatrics ward

目的:总结分析临床药师对老年医学科病房的医嘱干预内容,提高药学服务质量,促进老年患者用药合理性。方法:收集并统计分析2014年1月至2015年12月两年间北京协和医院老年医学科临床药师医嘱干预记录。结果:临床药师共干预老年医学科医嘱993例,涉及问题类型较多的是不良反应(ADR)相关问题(22.2%)、药物选择(20.5%)及用法用量(19.4%)等,涉及药物种类以心血管系统用药(25.8%)、内分泌系统用药(17.6%)、神经精神系统用药(12.3%)及抗感染药物(11.8%)居多。结论:本文突出了临床药师对老年人医嘱审核干预及药物重整,避免用药相关问题的重要角色,强调医生与药师合作的重要性。

Objective: To summarize and analyze the role of clinical pharmacist's medication order interventions in the division of geriatric ward in improving the quality of pharmaceutical care and promoting the rational use of drugs in elderly patients. Methods: The medication order intervention records in the division of geriatrics ward from January 2014 to December 2015 were collected and analyzed. Results: A total of 993 intervention records were collected. Interventions were mostly related to "adverse drug reactions(22.2%)", "drug selection(20.5%)", "usage and dosage(19.4%)". The main categories of medications involved cardiovascular drugs(25.8%), endocrine drugs(17.6%), central nervous system drugs(12.3%) and anti-infective drugs(11.8%). Conclusion: This study highlights the role of routine pharmacist in medication order review and medication reconciliation to prevent drug-related problems in elderly patients and gives new insights for a successful collaboration between physicians and pharmacists.