对临床药学焦点问题的认识ppt课件

对临床药学 焦点问题的认识,邵 宏 史录文 北京大学药学院药事管理与临床药学系,主要内容,对临床药学内涵的理解 临床药师为谁而工作？ 临床药师主要干什么？ 临床药师都在哪里工作？ 临床药师的水平如何分出高下？ 行业协会与药师的认证评估 我国临床药学的可持续发展,何为临床药学？,ACCP和ESCP的定义： Clinical Pharmacy is a commonly used term in pharmacy practice and in pharmacy literature 形式 药学实践 (Pharmacy Practice) It describes the activities and services of the clinical pharmacist to develop and promote the rational and appropriate use of medicinal products and devices 核心 合理用药 药学监护 (Pharmaceutical Care) necessary philosophy and mission of pharmacy practice, a basic patient need 临床药学对人，药学对物 Revolution or Renaissance ? 临床药学是医疗发展的结果,何为临床药师？,美国药学人员的分类 Pharmacist (Pharmacy specialist, Clinical Pharmacist) Pharmacy technician 临床药师 Part or Full ？ FTE Pharmacists (Full Time Equivalent，40 hrs/w) 临床药师的数量和学位 药师的社会地位,临床药师的工作对象与工作性质,工作对象医师 or 患者? 工作性质监管 or 服务? 工作手段 工作性质 鉴别、解决、预防潜在的或实际发生的DRPs 工作目的 工作内容 改善患者生命质量(quality of life),临床药师的工作内容,药师职业角色的发展 药学实践 (Pharmacy practice) 药学实践的几种模式 美国药师岗位培训 Residency 美国药师继续教育规范,临床药师的工作范围,ACCP和ESCP It includes all the services performed by pharmacists practising in hospitals, community pharmacies, nursing homes, home-based care services, clinics and any other setting where medicines are prescribed and used 药学实践的主要方向 我国现阶段的情况主要在三甲医院,临床药师的工作层次,初级（Fundamental） 在对病人提供安全的药学监护中起关键作用 18项具体指标 中级（Desirable） 提供更专业化和专科化的药物治疗学服务 13项具体指标 高级（Optimal） 提供整合的、专业化的和精细的专科服务，旨在通过最高层次的教学、研究和药物治疗实践活动优化药物治疗效果 12项具体指标,Rudis MI and Brandl KM. Crit Care Med 2000; 28(11):3747 南加州大学；新墨西哥州大学,每个等级都包含了4个方面的活动： clinical, educational, administrative, scholarly,行业协会与药师的认证评估,APhA American Pharmacist Association (1852) NARD National Association of Retail Druggists (1898) NABP National Association of Boards of Pharmacy (1904) ACPE Accreditation Council for Pharmacy Education (1932) AACP American Association of Colleges of Pharmacy (1937) ASHP American Society of Health-System Pharmacists (1942) ASCP American Society of Consultant Pharmacists (1969) ACCP American College of Clinical Pharmacy (1979) AAPS American Association of Pharmaceutical Scientists (1986) NISPC The National Institute for Standards in Pharmacist Credentialing (1998) ESCP European Society of Clinical Pharmacy,The Board of Pharmaceutical Specialties (B.P.S.) 1976 Nuclear Pharmacy (1978) BCNP Nutrition Support Pharmacy (1988) BCNSP Pharmacotherapy (1988) BCPS Psychiatric Pharmacy (1992) BCPP Oncology Pharmacy (1996) BCOP,The Commission for Certification in Geriatric Pharmacy (C.G.P.) 1997,Certified Disease Manager (C.D.M.) of diabetes, asthma, dyslipidemia, and anticoagulation therapy.,2006年美国临床药师工作状况,MacLaren R, Rudis MI, et al. Ann Pharmacother 2006; 40:612-8 科罗拉多州大学；南加州大学 382个医疗机构,我国临床药学的可持续发展,处于初级起始阶段 普通药师与临床药师并存，需设立适当门槛，普通药师需经过专门培训合格后方可成为临床药师 临床药师社会化由医院临床药师逐渐向社区临床药师发展,我国临床药学的可持续发展,人才培养是可持续发展的根本 数量与质量由少而精逐渐往多而专发展 大专院校人才储备 要多层次多方向培养 不同院校应根据自己的特点进行某些层次某些方向的培养 明确普及教育与精英教育、理学(学位)教育与专业(职业)教育的不同教学目标和教学方式 岗位人才培训 将转型培训与继续教育分开 转型培训以初级岗位培训项目为主 继续教育以中级和高级培训项目为主 由全能型培养往方向型培养转换,我国临床药学的可持续发展,相关制度的跟进是可持续发展的保障 临床药师岗位制度 “编制、配比、分级”从“三无”到“三有” 临床药师的“头衔”可以在现有药师职称的基础上附加，无需另设职称 认证与评估制度,Help individual hospital inpatients and nonhospitalized patients achieve the best use of medications. Apply evidence-based methods to the improvement of medication therapy. Improving the safety of medication use. Apply technology effectively to improve the safety of medication use. Engage in public health initiatives on behalf of their communities.,Thanks !,MONEY Magazine 2006 Career Survey,Pharmacists 9/50 Stress: B Flexibility: C Creativity: B Difficulty: C Ten Year Growth: 24.5% Average Pay: $91,988,临床药师的数量与学位,Physicians Attending Fellow Resident Intern Medical student Physician assistant & Nurse practitioner Nursing Staff Pharmacists Pharmacy Specialist Preceptor & Resident Instructor & Pharm.D. student Dieticians Housekeepers Ethics Committee,Health Care Team,Pharmaceutical Care,Self-Care,Drug Information,Clinical,Distributive,沟通技巧,药学实践的模式,为促进健康和预防疾病准备教育材料 利用分析技术影响药物利用和药物利用策略,具有健康筛查和诊断的技巧，药物治疗方案的设计与推介，治疗方案的判别,药物治疗方案的设计、推介、监测和评估,药物治疗方案的设计、推介、监测和评估 利用高级沟通技巧与患者形成合作关系并参与医疗团队的决策 工作的重心由解决用药相关问题转移到关注患者生存质量,具有药品准备与分发的技巧,Nimmo CM and Holland RW. AJHP 1999; 56:1981-7,Total Pharmacy Care (TPC),美国药师岗位培训Residency,Job (practice) Residency Ph.D.,Pharm.D.,Pharmacist Teacher & Researcher Pharmacy technician （药技师，无执业药师资格）,PGY1 (普通培训) PGY2 (专科培训),Licensed Pharmacist,Board certification,BCPS BCOP BCPP BCNSP BCNP,测试与评估,Residency Protest for Pharmacokinetics,转科,Resident主要工作内容,药学服务(Pharmacy Service) 查房前更新药历 Patient Profile & SOAP 随治疗团队常规查房 Round Worksheet 上报不良反应报告、用药差错报告 实时网络 填写相关病例单 Pharmacist Worksheet 提供药物信息和教育 向指导药师(Advisor)汇报病例 用药医嘱与药学服务 Pharmacotherapy Workup 24小时On-Call制度和中心药房服务 教学活动(Educational Activities) 课堂学习与科研活动(Scholarly Activities),Patient Profile,SOAP,Round Worksheet,Pharmacist Worksheet,Pharmacotherapy Workup (1),Pharmacotherapy Workup (2),Pharmacotherapy Workup (3),Resident部分课程,Medical Library and Resources Medication Histories Anemia Protocol, Intensive Insulin, Sedation Pediatric Overview Pharmacokinetic Services IV Compounding /Sterile Techniques Nutrition Support Services PharmacistCare Diabetes Class PharmacistCare Cardiovascular Class Anticoagulation clinic Pharmacy Administration STLC (Scholarship of Teaching & Learning Certificate Program) Pharmacy Grand Rounds （每周1次）,STLC (Scholarship of Teaching & Learning