Training of clinical pharmacists in psychiatric pharmacy services during the prevention and treatment of COVID-19

A series of pharmacy services of clinical pharmacists at the Wuhan Mental Health Center during the prevention and treatment of Coronavirus disease 2019(COVID-19),such as participation in the formulation of COVID-19 prevention and treatment plans suitable for psychiatric departments,popular science of pharmacy,medical order review,real-time intervention,and medication education are summarized here.Due to the sudden public health incident,the service model of psychiatric clinical pharmacists should be addressed,as clinical pharmacists are an important part of the diagnosis and treatment of psychiatric diseases.Among the majors currently available in the clinical pharmacy training base curriculum,no psychiatry major has been set up in China yet;therefore,in this paper,we provide guidance in psychiatry pharmacy for those who wish to integrate clinical teams.

Experience of clinical pharmaceutical care carried out in pediatric respiratory department

Objective To discuss the role of clinical pharmacists in providing pharmaceutical care in pediatric respiratory department.Methods Supply pharmaceutical information,participate in clinical rounds,provide the rationalization proposal,help doctors to formulate correctly dose regimen,enhance medication efficiency;establish medicine record for the patient,record the drugs which were used,provide pharmaceutical care for the patient such as disease propaganda,medicine-use education,medicine consultation and so on.Results Promote rational administration,enhance the security of medical practice,the clinical pharmacists' work obtains the doctors' approval;improve the medication compliance,reduce patients' economy and spiritual burden,and obtain the patients' trust.Conclusions The pharmaceutical care carried out in pediatric respiratory department can help reduce the incidence of medication errors,cut down the medication cost,shorten the time of patients to be hospitalized,raise the medication efficiency,and promote the doctor-patient relationship harmoniously.In a word the clinical pharmacists are indispensable.

Effectiveness of Clinical Pharmacist Directed-Diabetes Management

Objective: The main aim of the study is predominately utilizing clinical pharmacist in the provision of continuing diabetic education programs to emphasize and re-emphasize the importance of risk factors, prevention, adherence to medication and behavioral changes to prevent recurrences of the disease, their progression, and ultimately minimize hospitalization. Specific goals are to improve clinical outcomes for patients with diabetes—to maintain optimal plasma glucose concentrations Fasting, Postprandial Plasma Glucose, and Glycated Hemoglobin. Study design: A prospective interventional study in the Outpatient General Medicine Department, for a period of six months from October 2018 to March 2019. Results: HbA1c levels were reduced from baseline by −1.107 ± 0.8634, Fasting Plasma Glucose levels and Postprandial blood glucose levels were reduced from baseline by −24.2218 ± 5.70352 and −30.1891 ± 1.40592 respectively. Conclusion: A trained clinical pharmacist by providing diabetes education and care can significantly reduce hyperglycemia, thereby improving the quality of life in diabetes patients and ultimately reducing health care costs associated with these morbidities.

The Impact of a Clinical Pharmacist in the Emergency Department of an Academic Hospital in the Kingdom of Saudi Arabia

Introduction： The department of emergency medicine （DEM） has a high-risk environment due to its unique and complex workflow. Many high-risk medications are ordered and administered at patients’ bedsides without being checked by a pharmacist first, which may lead to an increase in the incidence of patient medication errors （MEs）. Objective： The current study evaluated the needs of the clinical pharmacy service in the DEM at King Saud University Medical City （KSUMC）, Riyadh, Saudi Arabia. Methods： A cross-sectional retrospective study was conducted between Jan 2016 to Dec 2017 and the documentation of clinical pharmacist interventions was extracted from Esihi database. Results： A total of 2,255 interventions for 862 patients were documented. The recommended interventions were as follows： 645 （dose adjustments）, 108 （therapeutic substitutions）, and 354 interventions （initiating drug therapy）. Adverse drug reactions （ADRs） were reported in 16 patients, and drug interactions were managed in 26 patients. The DEM responded to 713 information inquires and 290 pharmacokinetic consultations. Drug discontinuations included 39 incidents （where unjustified drug prescription occurred）, 37 （where contraindications were involved）, and 19 （where duplicate therapy was involved）. The most common interventions were related to the following drugs： antibiotics （34%）, anticoagulants （15%）, and anticonvulsants （10%）. The acceptance rates for the EM clinical pharmacist recommendations increased from 93.9% in 2016 to 99% in 2017. The most common outcome for interventions was to optimize the therapeutic effects of the drugs that were administered （73%）. Reconciliation was done in 796 patients. Conclusions： The clinical pharmacy service plays a critical role in the management of patients in the emergency department （ED）.

The effect of pharmaceutical care in the elderly patients with type 2 diabetes mellitus

Pharmaceutical care plays a crucial role in reducing mortality and morbidities of the patients.A hospital based quasiexperimental study was conducted with elderly patients with type 2 diabetes who attended at the diabetes clinic of No.(2)Military Hospital(500-Bedded)in Myanmar from April 2013 to February 2014.The aim of this study was to evaluate the effect of pharmaceutical care in elderly patients with type 2 diabetes mellitus.A total of 52 respondents enrolled in this study.The clinical outcomes and quality of life of patients before and eight months after intervention were assessed.Pharmaceutical care program was implemented as intervention.Of the total number of respondents,52 drug related problems were identified.

Peking University Health Science Center Model of Clinica Pharmacy Education and Clinical Pharmacist Services

In the 1950s, clinical pharmacy emerged in the United States and gradually developed into an indispensable component of the clinical services system, The American College of Clinical Pharmacy defines clinical pharmacy as a pharmaceutical field that focuses on the science and practice of rational drug use.

Impacts from the implementation of a Novel Clinical Pharmacist Training Program in Changsha,Hunan Province,China

The Ministry of Health and Family Planning of the People’s Republic of China issued a mandate to all hospitals to implement clinical pharmacy services by 2020.Implementation of clinical pharmacy services to provide pharmaceutical care is a priority.The Second Xiangya Hospital of Central South University in collaboration with the University of Alberta implemented a structured train-the-trainer program to train pharmacists to provide direct patient care in collaboration with physicians,to teach/mentor other pharmacists and students from Hunan province,and to conduct clinical pharmacy research.Following implementation of the program,the pharmacy department increased the number of clinical pharmacists,expanded the clinical pharmacy services,made changes to hospital policies,and received a financial award of five million renminbi(one million Canadian dollars)to support the department.

A study of drug therapy problems in pharmaceutical care

We evaluated the frequency and category distribution of drug therapy problems in young and elderly patients. A retro- spective study of the medical conditions, drug therapies, and drug therapy problems identified in 102 patients was performed. The patients were divided into young patient group （〈65 years of age） and elderly patient group （〉~ 65 years of age） in a hospital pharmacy setting. Inclusion criteria： patients who were referred by the treating doctors and received evaluation by the clinical pharmacists. Exclusion criteria： patients who were unable to or refused to be evaluated by the clinical pharmacists. We found that 1） Patients in young and elderly groups had a mean of 3 and 5 medical conditions per person, respectively （P = 0.001）. 2） On the average, they took 4 and 7 drug therapies per person, respectively. The elderly patients took a significantly higher number of drug therapies （P = 0.001）. 3） Totally 85 drug therapy problems in 7 categories were identified within 102 patients. 4） 36.8% of young patients experienced 1 to 4 drug therapy problems whereas 61.8% of elderly patient experienced I to 5 drug therapy problems. Drug therapy problems were significantly more prevalent in elderly patients （P = 0.017）. 5） The drug therapy problem by category had similar distribution in young and elderly patients. The elderly patients in this study encountered more drug therapy problems than young patients. Accordingly, more attention should be paid to elderly patients in pharmaceutical care practice.

Clinical decision support for drug related events: Moving towards better prevention

Clinical decision support(CDS) systems with automated alerts integrated into electronic medical records demonstrate efficacy for detecting medication errors(ME) and adverse drug events(ADEs). Critically ill patients are at increased risk for ME, ADEs and serious negative outcomes related to these events. Capitalizing on CDS to detect ME and prevent adverse drug related events has the potential to improve patient outcomes. The key to an effective medication safety surveillance system incorporating CDS is advancing the signals for alerts by using trajectory analyses to predict clinical events, instead of waiting for these events to occur. Additionally, incorporating cutting-edge biomarkers into alert knowledge in an effort to identify the need to adjust medication therapy portending harm will advance the current state of CDS. CDS can be taken a step further to identify drug related physiological events, which are less commonly included in surveillance systems. Predictive models for adverse events that combine patient factors with laboratory values and biomarkers are being established and these models can be the foundation for individualized CDS alerts to prevent impending ADEs.

1例肺血栓栓塞症伴多种合并症乳腺癌患者的抗凝治疗分析与药学监护

目的 为肺血栓栓塞症(PTE)伴多种合并症乳腺癌患者的抗凝治疗和药学监护提供参考。方法 临床药师参与1例PTE合并继发于系统性红斑狼疮的可疑抗磷脂综合征伴血小板重度减少的乳腺癌患者的诊疗过程,并提供制订个体化抗凝方案、监测患者出血情况等药学监护。针对患者出现的PTE,临床药师建议停用所有乳腺癌治疗药物;针对初始抗凝方案,临床药师在明确血小板重度减少并非抗凝治疗的绝对禁忌证后,建议予磺达肝癸钠注射液抗凝治疗;针对长期抗凝方案和疗程,临床药师建议优选华法林,推荐疗程至少3~6个月,并根据12周后的抗磷脂抗体谱复查结果结合肿瘤治疗方案决定是否进行无限期抗凝治疗。结果 医师采纳临床药师建议。经治疗后,患者血丝痰及气促消失,血小板恢复正常,准予带药出院。结论 临床药师以“抗凝-出血”为切入点,通过分析乳腺癌治疗相关药物与PTE的因果关系、充分评估患者的出血和血栓复发风险、监测患者出血症状和体征及凝血指标等药学服务,为患者制定了个体化用药方案,保障了患者用药的安全有效。

临床药师通过不同切入点参与肾移植受者围妊娠期药学服务的案例分析

临床药师从不同切入点为处于不同妊娠阶段的肾移植受者提供药学服务,包括妊娠早期药物对胎儿的安全性影响评估、妊娠晚期基于药物相互作用及不良反应的治疗方案优化、围术期镇痛方案的个性化选择以及哺乳期药物的安全性评估。医师或患者接受并采纳临床药师的建议,母体疾病得到有效控制,胎儿健康分娩。临床药师对肾移植受者提供的围妊娠期药学服务有助于提升该特殊群体的用药安全性、合理性。

临床药师参与1例婴儿难治性重症沙眼衣原体肺炎治疗的药学实践

目的探讨临床药师在婴儿难治性重症沙眼衣原体肺炎治疗过程中的作用。方法临床药师查阅国内外文献,对婴儿沙眼衣原体肺炎的流行病学、临床特征、微生物检测及抗感染治疗方案进行分析和讨论,并结合患儿实际病情提出个体化用药建议。结果临床医师采纳临床药师建议,采用呼吸道病原体靶向测序技术检测出沙眼衣原体。在考虑婴儿用药安全性、有效性及依从性的基础上,加用阿奇霉素静脉给药抗沙眼衣原体感染,并成功治愈出院。结论临床药师参与婴儿沙眼衣原体肺炎抗感染用药方案的制订,确保了用药的安全性和有效性,并提出相关建议,为临床治疗婴儿沙眼衣原体肺炎提供了依据和方向。

临床药师参与一例妊娠合并胆囊炎的药学实践和体会

目的探讨临床药师在妊娠合并急性胆囊炎治疗中促进合理用药的作用,为临床类似病例治疗的药学实践提供参考。方法以某院收治的1例妊娠合并急性胆囊炎患者为例,根据患者的特殊生理状况与疾病用药特点,从药物选择、疗效、并发症以及不良反应等方面进行分析,为患者制定有效的治疗方案。结果临床药师协助临床医生制定个体化治疗方案并提供药学服务,使疾病得到良好控制,改善了围生期母婴结局。结论临床药师是治疗团队的一员,应该与医生、护士共同组成救治团队,参与临床救治,并可在妊娠合并胆囊炎的药物使用方面发挥专业优势。

1例免疫缺陷患儿播散性马尔尼菲篮状菌感染的药学监护

目的为临床安全、合理治疗免疫缺陷患儿播散性马尔尼菲篮状菌(TM)感染提供参考。方法临床药师通过参与1例免疫缺陷患儿播散性TM感染的治疗,结合相关指南、专家共识、患儿检查结果对其抗真菌用药的选择、药品不良反应(ADR)等实施药学监护。结果基于患儿的血培养结果为TM,临床药师建议予两性霉素B脱氧胆酸盐抗真菌;但患儿仍反复高热,痰培养结果仍为TM,考虑为播散性TM,建议加用注射用伏立康唑联合抗真菌;患儿病情稳定后,调整为伏立康唑片单药口服治疗。同时建议行基因检测,结果提示X连锁高免疫球蛋白M综合征,出院继续口服伊曲康唑口服液维持治疗。随访6个月,患儿预后良好,无复发。结论目前,尚无关于预防及治疗免疫缺陷患儿播散性TM感染的标准或指南,临床药师参与免疫缺陷患儿播散性TM感染的药学监护,可提高合理用药水平,保障用药安全。

一例感染性心内膜炎合并重度主动脉瓣反流患者的药学监护

目的探讨临床药师在感染性心内膜炎合并重度主动脉瓣反流患者诊疗过程中的作用。方法临床药师以1例感染性心内膜炎合并重度主动脉瓣反流的治疗为例,分析患者临床特点、诊治方案并实施全程药学监护。结果经积极治疗后,患者转归较好。结论临床药师及时发现患者诊疗过程中出现的不良反应并给出治疗建议。患者转归较好,体现了临床药师的服务价值。

基于CICARE沟通模式咳喘药学服务门诊药患沟通流程的建立

基于美国CICARE沟通模式,结合咳喘药学服务门诊(CWPC)患者疾病的特殊性及药师提供药学服务的实践经验,建立CWPC的药患沟通流程,并将有效的沟通技巧运用到CICARE沟通流程中,包括礼貌接触、全面介绍、专业沟通、关心询问、耐心解答、适时离开等六个环节中,旨在提高药学服务工作效率及防范药患纠纷的能力。该沟通流程利于药师与患者建立良好的沟通关系,为药师与咳喘慢病患者沟通交流过程中提供标准化、流程化的指导,为深入开展全程化、个体化药学服务奠定实践基础。

MDTcare模式下的癌痛药学监护实践1例

目的探讨临床药师参与癌痛多学科团队照护(MDTcare)的工作模式。方法通过1例癌痛患者镇痛治疗期间出现阿片类药物相关不良反应,临床药师在MDT团队中提出个体化治疗方案调整建议,参与患者用药指导和教育,阐述了临床药师的重要作用。结果MDTcare模式下,临床药师与医师紧密协作,患者疼痛控制满意。结论作为MDT团队的成员,临床药师通过优化治疗方案,提供药学监护,保障了患者用药安全有效。

基于内容分析法的临床药师岗位胜任力指标构建

目的 对国内外临床药师胜任力评价指标进行内容分析,为临床药师岗位胜任力构建提供参考。方法 检索国内外临床药师岗位胜任力相关文献,采用内容分析法对符合标准的文献进行分析。结果 最终纳入22篇文献及14篇胜任力评估框架及模型,提取个人素质、知识、个人能力、药学服务、教研5个一级类目、15个二级类目及61个三级类目。结论 初步构建了临床药师岗位胜任力指标体系,为临床药师开展实践工作提供参考。

视频和节点提醒用于结肠镜检查肠道准备患者药学服务效果分析

目的探讨临床药师利用视频和节点提醒的药学服务对结肠镜检查肠道准备质量、不良反应发生情况、健康教育指导满意度的影响。方法选取医院消化内科2021年1月至12月接受结肠镜检查的住院患者216例,按肠道准备指导方式分为干预组和对照组,各108例。对照组患者给予肠道准备方案及复方聚乙二醇电解质散,以及传统纸质肠道准备指导单进行健康教育指导;干预组患者在对照组基础上由临床药师利用视频和节点提醒进行肠道准备健康教育。比较两组患者肠道准备质量的合格率和不良反应发生率,并同时调查患者对临床药师健康教育指导的满意度。结果干预组肠道准备质量合格率为87.96%,显著高于对照组的67.59%(P<0.05);干预组患者波士顿肠道准备评分量表(BBPS)评分显著高于对照组(P<0.05);干预组患者呕吐、腹胀不良反应发生率分别为5.56%和7.41%,均显著低于对照组的12.96%和13.89%(P<0.05)。干预组患者对临床药师健康教育指导的满意率为90.82%。结论临床药师利用视频和节点提醒的药学服务可显著提高结肠镜检查患者的肠道准备质量,减少呕吐、腹胀等不良反应,且患者满意度高。

临床药学专业抗感染PBL案例库的建设与探索

抗菌药物合理使用已成为临床药学实践教学的重要内容之一。传统的教学方式存在局限性,往往不能有效提升学生在实际临床工作中抗菌药物合理使用的能力。为解决这一问题,笔者研究了以以问题为基础的教学法(problem-based learning,PBL)为基础的案例库建设在抗菌药物合理使用教学中的应用;探讨了PBL案例库在抗菌药物合理使用教学中的重要意义和实用性。它不仅能激发学生的主动学习兴趣,还有助于培养其跨学科团队合作和临床决策能力。文章还明确了PBL案例库编写的基本原则、方法以及案例的结构和内容,以确保建设案例库的可行性。本研究在临床药学专业硕士研究生教育中的实践证明,该方法适用于现代教学模式,有望显著提高抗菌药物合理使用教学的质量和效果,具有重要的教学和临床实践意义。