1、美國藥師藥學(xué)實(shí)踐北京大學(xué)第三醫(yī)院藥劑科楊 麗2022/10/21ASHP對藥師的定義 藥師的任務(wù)是提供藥學(xué)保健，藥學(xué)保健是直接、負(fù)責(zé)地提供與藥物治療相關(guān)的保健，其目的是達(dá)到改善病人生命質(zhì)量的確切效果。 2022/10/22北京大學(xué)第三醫(yī)院藥劑科美國藥師的資格具有 Pharm.D.學(xué)位通過全美藥師資格統(tǒng)一考試通過當(dāng)?shù)胤煽荚嚾〉盟帋焾?zhí)照直接工作 or 住院藥師培訓(xùn)Pharmacy Residency Program2022/10/23工作內(nèi)容藥學(xué)院教師營養(yǎng)支持藥師社區(qū)藥房藥師腫瘤專科藥師普通制劑手術(shù)室藥師重癥監(jiān)護(hù)藥師兒科?？扑帋熕幬镄畔⑺幏拷?jīng)營管理醫(yī)院藥房藥師毒物控制?？扑帋熱t(yī)院臨床藥師零售藥店

2、藥師傳染疾病藥師 精神專科藥師養(yǎng)老院藥師 公共衛(wèi)生服務(wù)藥學(xué)管理 普通藥師部隊(duì)醫(yī)院藥師獸醫(yī)藥師核醫(yī)學(xué)?？扑帋?022/10/24北京大學(xué)第三醫(yī)院藥劑科藥師著裝職業(yè)化職業(yè)服裝白大褂整潔、干凈有利于控制交叉感染不允許穿便服和便鞋必須佩戴標(biāo)明藥師姓名和醫(yī)療級別的身份牌提高藥師職業(yè)形象增加患者的信任感2022/10/25北京大學(xué)第三醫(yī)院藥劑科Patient Care ProcessBuild a relationship!自我介紹簡述談話目的 輕松氣氛了解患者所需期望, 治療目標(biāo), 顧慮談話技巧開放式提問鼓勵傾聽總結(jié)“早上好！李先生。我姓楊，是主管你的住院藥師。我需要向您了解一些信息，以便更清楚地了解您

3、的情況。您不介意我問一些問題吧？”2022/10/27北京大學(xué)第三醫(yī)院藥劑科I. 患者評估 Patient Assessment1. 收集相關(guān)信息2. 評估藥物治療相關(guān)需求3. 確定藥物治療問題文件記錄Pharmacotherapy Workup Notes所有病史及用藥史信息被歸納入一個結(jié)構(gòu)化的表格中！2022/10/28北京大學(xué)第三醫(yī)院藥劑科SOCIAL DRUG USESubstanceHistory of UseSubstanceHistory of UseTobacco_ No tobacco use_ 0-1 packs per day_ 1 packs per day_ prev

4、ious history of smoking_ attempts to quit Alcohol_ No alcohol use_ 1-2 drinks per week_ 3-6 drinks per week_ 6 drinks per week_ history of alcohol dependenceCaffeine_ No caffeine use_ 6 cups per day_ history of caffeine dependenceOtherrecreationalDrug useALLERGIES & ALERTSMedication Allergies (drug,

5、 timing, reaction - rash, SOB, angioedema, anaphylaxis)Adverse reactions to drugs in the past (Intolerances)Other Alerts/Health Aids/Special Needs (sight, hearing, mobility, literacy, disability)2022/10/210北京大學(xué)第三醫(yī)院藥劑科CURRENT MEDIAL CONDITIONS AND MEDICATIONSIndicationDrug ProductDosage Regimendose,

6、route, frequency, durationStart DateResponseeffectiveness/safetyPAST DRUG THERAPIESIndicationDrug TherapyResponseDate2022/10/211北京大學(xué)第三醫(yī)院藥劑科PAST MEDICAL HISTORY (relevant illnesses, hospitalization, surgical procedures, injuries, pregnancies, deliveries)PHARMACISTS OBSERVATIONS(MEDICATION EXPERIENCE)

7、What is the patients general attitude toward taking medication?Needs attention in care planY NWhat does the patient want/expect from his/her drug therapy?Needs attention in care planY NWhat concerns does the patient have with his/her medications?Needs attention in care planY NTo what extent does the

8、 patient understand his/her medications?Needs attention in care planY NAre there cultural, religious, or ethical issues that influence the patients willingness to take medications?Needs attention in care planY NVital SignsBP_/_ HR _bpm Resp Rate _ Temp _2022/10/212北京大學(xué)第三醫(yī)院藥劑科Drug Therapy Problem Ide

9、ntification/Characterizationdrug therapy problemsmedical condition and drug therapy involvedindicationUnnecessary Drug Therapy_No medical indication_Duplicate therapy_Nondrug therapy indicated_Treating avoidable ADR_Addictive/recreationalNeeds Additional Drug Therapy_Untreated condition_Preventative

10、/prophylactic_Synergistic/potentiatingmedical condition and drug therapy involvedeffectivenessNeeds Different Drug Product_More effective drug available_Condition refractory to drug_Dosage form inappropriate_Not effective for conditionDosage too low_Wrong dose_Frequency inappropriate_Drug interactio

11、n_Duration inappropriatemedical condition and drug therapy involvedsafetyAdverse Drug Reaction_Undesirable effect_Unsafe drug for patient_Drug interaction_Dosage administered or changed too rapidly_Allergic reaction_Contraindications presentDosage Too High_Wrong dose_Frequency inappropriate_Duration

12、 inappropriate_Drug interaction_Incorrect administrationmedical condition and drug therapy involvedcomplianceNoncompliance_Directions not understood_Patient prefers not to take_Patient forgets to take_Drug product too expensive_Cannot swallow/administer_Drug product not available2022/10/214北京大學(xué)第三醫(yī)院藥

13、劑科II. 監(jiān)護(hù)計(jì)劃 Care plan developmentPharmacotherapy Workup notes CARE PLANINDICATION (medical condition) HISTORY OF THE PRESENT ILLNESS OR MEDICAL CONDITION (including previous approaches to treatment and responses)GOALS OF THERAPY (improvement or normalization of signs/symptoms/laboratory tests or redu

14、ction of risk)1.2.DRUG THERAPY PROBLEMS to be resolved_None at this timeTherapeutic Alternatives (to resolve the drug therapy problem and rationale)1.2.2022/10/215北京大學(xué)第三醫(yī)院藥劑科III. 隨訪評估 Follow-up evaluationPharmacotherapy Workup notes FOLLOW-UP EVALUATIONMedical Condition (Indication): _Outcome Parame

15、terPretreatmentBaseline (Date)First Follow-up(Date)Second Follow-up(Date)EffectivenessSign/symptomSign/symptomLab valueLab valueSafetySign/symptomSign/symptomLab valueLab valueOther2022/10/217北京大學(xué)第三醫(yī)院藥劑科statusSTATUSInitial: goals being established, initiate new therapyResolve: goals achieved, therap

16、y completedStable: goals achieved, continue same therapyImproved: adequate progress being made, continue same therapyPartial Improvement: progress being made, adjustments in therapy requiredUnimproved: no progress yet, continue same therapyWorsened: decline in health, adjust therapyFailure: goals no

17、t achieved, discontinue current therapy and replace with different therapyNew Drug Therapy Problems Identified_none at this time_documented_none at this time_documentedDateSchedule for next follow-upCommentsSignature_ Date_2022/10/218北京大學(xué)第三醫(yī)院藥劑科Excellence In Progress2005 Rankings: Colleges of Pharma

18、cyRANK Assessment score (5.0)1. University of California-San Francisco 4.62. University of Texas-Austin 4.43. University of North Carolina-Chapel Hill 4.24.Purdue University 4.1 University of Arizona 4.1 University of Michigan Ann Arbor 4.1 University of Minnesota Twin Cities 4.18.University of Kentucky 4.0 University of Illinois Chicago 4.0 University of Maryland Baltimore 4.02022/10/219北京大學(xué)第三醫(yī)院藥劑科臨床藥學(xué)實(shí)踐內(nèi)容醫(yī)院藥學(xué)實(shí)踐 Hospital Pharmacy Practice特殊患者藥學(xué)服務(wù) Specialty Population Practice 藥師門診實(shí)踐 Ambulatory Care Practice社區(qū)藥學(xué)實(shí)踐 Community Phar