课件：对临床药学焦点问题的认识邵宏.ppt

对临床药学 焦点问题的认识,邵 宏 北京大学药学院药事管理与临床药学系,ACCP (American College of Clinical Pharmacy). , 2008,主要焦点问题,如何理解临床药学和药师的内涵？,何为临床药学？ Clinical Pharmacy,临床(clinical)的概念 【美国传统词典】Involving or based on direct observation of the patient 【高级汉语词典】接触病人，诊治疾病 ACCP和ESCP的权威定义 形式 药学实践(Pharmacy Practice) Clinical Pharmacy is a commonly used term in pharmacy practice and in pharmacy literature 核心 合理用药 the activities and services of the clinical pharmacist to develop and promote the rational and appropriate use of medicinal products and devices 使命与患者基本需求 药学监护(Pharmaceutical Care) necessary philosophy and mission of pharmacy practice, a basic patient need 历史地位：Revolution or Renaissance ? 临床药学是医疗发展的必然结果,先进 (美国),发达 (欧澳日),发展中 (中国),初期,落后,药师职业与国家临床药学水平,医院药师,临床药师50%,医院药师,临床药师50%,医院药师,社区药师,药学专家,药师,药师 (社会药师),社会药师,社会药师,美国药学院校教学重心转移,何为临床药师？ Clinical Pharmacist,临床药师是为患者提供药学服务的药学专家（Pharmacy Specialist） 美国药学人员的分类 Pharmacist (Pharmacy specialist, Clinical Pharmacist) Pharmacy technician 临床药师相关问题 Part or Full ？ FTE Pharmacists (Full Time Equivalent，40 hrs/w) 临床药师的数量、学位和社会地位,临床药师的数量,临床药师的学位,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,主要焦点问题,如何理解临床药学和药师的内涵？ 临床药师为谁而工作？如何工作？,工作对象： 医生 or 患者？,工作环境： 个人 or 群体？,Physicians Attending Fellow Resident Intern Medical student Physician assistant & Nurse practitioner Nursing Staff Pharmacists Pharmacy Specialist Preceptor, Advisor & Resident Instructor & Pharm.D. student Dieticians Housekeepers Ethics Committee,Health Care Team,工作性质： 监管 or 服务？,工作手段,鉴别、解决、预防 潜在的或实际发生的 DRPs,Types of Drug-Related Problems,工作步骤,通过PWDT 完成一个具体的 服务项目,PWDT Pharmacists Workup of Drug Therapy,工作目的,通过药物治疗 达到预定疗效 来改善患者生命质量,主要焦点问题,如何理解临床药学和药师的内涵？ 临床药师为谁而工作？如何工作？ 临床药师主要干什么？,药师职业角色的发展,药学实践 Pharmacy Practice,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),工作的主要内容,对医务人员和病人及其家属进行教育，讲座与宣传等,Scholarly Activities,理论课学习,Scholarly Activities,科学研究,工作的主要内容,对医务人员和病人及其家属进行教育，讲座与宣传等,Points of Pharmacy Practice,查房前更新药历 Patient Profile & SOAP,Patient Profile,SOAP,Subjective 患者主诉,Objective 体检信息,Objective 体检信息,Objective 体检信息,Objective 体检信息,Objective 体检信息,Objective 体检信息,Assessment 评估,Plan 治疗方案,Points of Pharmacy Practice,查房前更新药历 Patient Profile & SOAP,随治疗团队常规查房 并进行病例讨论,Round Worksheet,Neurosurgery ICU Round,Pulmonary ICU Round,Cardiology Round,Points of Pharmacy Practice,查房前更新药历 Patient Profile & SOAP,随治疗团队常规查房 并进行病例讨论,DRPs分析,Points of Pharmacy Practice,查房前更新药历 Patient Profile & SOAP,随治疗团队常规查房 并进行病例讨论,DRPs分析,Worksheet；提供药物信息和教育,上报不良反应报告、用药差错报告 实时网络,Worksheet,Routine Work,Points of Pharmacy Practice,查房前更新药历 Patient Profile & SOAP,随治疗团队常规查房 并进行病例讨论,DRPs分析,用药医嘱与药学服务 Pharmacotherapy Workup,Worksheet；提供药物信息和教育,上报不良反应报告、用药差错报告 实时网络,Pharmacotherapy Workup,Assessment,Care Plan,Followup,Pharmacotherapy Workup,Assessment,Care Plan,Followup,Pharmacotherapy Workup,Assessment,Care Plan,Followup,Points of Pharmacy Practice,查房前更新药历 Patient Profile & SOAP,随治疗团队常规查房 并进行病例讨论,DRPs分析,用药医嘱与药学服务 Pharmacotherapy Workup,Worksheet；提供药物信息和教育,上报不良反应报告、用药差错报告 实时网络,24小时On-Call制度和中心药房服务,主要焦点问题,如何理解临床药学和药师的内涵？ 临床药师为谁而工作？如何工作？ 临床药师主要干什么？ 临床药师都在哪里工作？,工作范围,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 哪里有用药的病人 哪里就有药学实践 哪里就有临床药师,药学实践的主要方向,主要焦点问题,如何理解临床药学和药师的内涵？ 临床药师为谁而工作？如何工作？ 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？,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,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,主要焦点问题,如何理解临床药学和药师的内涵？ 临床药师为谁而工作？如何工作？ 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？ 如何保持和提高临床药学工作水平？,职业培训与继续教育 Continuing Education,普通药师,临床药学专业毕业生,美国药师岗位培训Residency,Job (practice) Residency (10%) PhD,PharmD,Pharmacist Academic Teacher & Researcher Pharmacy technician (No License),PGY1 (普通培训) PGY2 (专科培训),Licensed Pharmacist,Board certification （有效期6年）,BCPS BCOP BCPP BCNSP BCNP,Hospital Retail stores (60%) Drug Company Government,50%,组织结构,Advisor,Preceptor,Resident,Instructor,Residency Executive Committee,Resident Program Director,Chief Resident,Beginning, Quarterly, Exit,Monthly or Daily,Daily,Conclusion,测试与评估,Residency Protest for Pharmacokinetics,转科,职业培训的评估内容,I. Provide Patient Care A. Gather information B. Identify problem C. Resolve problem D. Collaborate with health care professionals E. Implement patient care plan F. Maintain medical record G. Display attitudes, values, habits H. Promote public awareness I. Provide information to health professionals J. Provide information to general public,II. Manage the Practice A. Manage Pharmacy Operations B. Manage Medication Distribution/Control C. Comply with laws,III. Manage Medication Use Systems A. Manage medication errors/adverse drug reactions B. Participate in drug use evaluations C. Understand formulary management D. Understand outcomes research/quality assessment,IV. General Ability-Based Professional Skills A. Thinking B. Communication C. Decision making D. Social and contextual awareness E. Social Responsibility F. Social Interaction G. Self-learning abilities,主要焦点问题,如何理解临床药学和药师的内涵？ 临床药师为谁而工作？如何工作？ 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？ 如何保持和提高临床药学工作水平？ 行业协会能为临床药学做些什么？,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.,美国药师继续教育规范,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.