美国临床药师的临床实践管见PPT课件.pptx

美国临床药师的临床实践管见,1,.,内容提要,美国医院从事药学技术工作的分类，配置的，比例和职责。美国的住院药师（在临床工作的，相当国内的临床药师）如何参与临床药物治疗工作，保证患者用药安全、合理用药的；制度、资质、工作流程、绩效、酬报等，有无书面的文书，如药历等。美国的住院药师在用药安全、合理方面做出的成绩，课题，数据等。,2,美国临床药师资质,本科药学管理硕士药学博士住院药师训练专业证书（BoardofPharmacotherapy)BoardCertifiedPharmacotherapySpecialistBoardCertifiedOncologySpecialistBoardCerfitifiedAmbulatoryCareSpecialistBoardCertifiedNutritionSupportSpecialistBoardCerfitifedPediatricSpecialistBoardCertifiedInfectiousDiseaseSpecialist,3,美国临床药师分类,政府机关教学机构保险公司医药公司的药物信息部医院住院部门诊（独立门诊和医院门诊）药店（独立或连锁）,4,医院临床药师分类职能,住院部中心药房普通病房专科病房（ICU,各个专科-心脏，肾脏，儿科，肿瘤，流行病，心理精神）门诊部内科和家庭医生门诊各个专科,5,推广临床药师的数据,五个花钱最多的病症糖尿病、心衰、高血压、高血脂、肺气肿五个返诊率最高的疾病心肌梗死、心衰、肾衰、呼吸系统疾病、精神病五个门诊病人最集中的科室心脑血管疾病、肿瘤、糖尿病、关节炎、肥胖,6,2010DiseaseTargets,GregoryDill,CentersforMedicare169(9):894-900.2.KoehlerBE,RichterKM,YoungbloodL,etal.Reductionof30-daypost-dischargehospitalreadmissionoremergencydepartment(ED)visitratesinhigh-riskelderlymedicalpatientsthroughdeliveryofatargetedcarebundle.JHospMed.2009;4(4):211-218.3.SchnipperJL,HamannC,NdumeleCD,etal.Effectofanelectronicmedicationreconciliationapplicationandprocessredesignonpotentialadversedrugevents:acluster-randomizedtrial.ArchInternMed.2009;169(8):771-780.4.BurroughsTE,WatermanAD,GallagherTH,etal.Patientsconcernsaboutmedicalerrorsduringhospitalization.JtCommJQualPatientSaf.2007Jan;33(1):5-14.,17,减少患者再次入院率,OneoutoffivepatientsdischargedfromaUShospitalwillbereadmittedin30days17.4billion(outof102.6billion,17%)ofMedicareannualcost,Jencks,SF,Williams,MV,Coleman,EA.RehospitalizationsamongPatientsintheMedicareFee-for-ServiceProgram.NEnglJMed2009;360:1418-1428.,18,行动方案,ReportedtothehospitalexecutivecommitteePresentedasolutionCollaboratedwithamultidisciplinaryteamMedicationsafetymanager,19,执行方案,Taketheadvantageofnewtechnology,20,PDSAModel,LangleyGL,NolanKM,NolanTW,NormanCL,ProvostLP.TheImprovementGuide:APracticalApproachtoEnhancingOrganizationalPerformance(2ndedition).SanFrancisco:Jossey-BassPublishers;2009:23-24,21,FailureModesandEffectsAnalysis(FMEA),IdentifypatientdischargingtoSNFatroundsSocialWorker(SW)obtainsbedandimmediatelypagesClinicalCoordinator(CC),MD,andPharmDMDhas4hourswithinwhichtowritethedischargeorders.Ifnotifiedafter2:00p.m.,MDmusthaveordersexceptI/Pdischargeinbefore8:00a.m.thenextday.CCscansordershourlyandpagesPharmD,22,FMEAProcess,PharmDandCChave2hourswithinwhichtocompletereview:PharmDreviewsmedicationorders.Ifissue,pagesMDtoreconcile.IfOK,sonotes:MarksasreviewedinMedRecscreenCCreviewsotherorders.Ifissue,pagesMDtoreconcile.CCchecksforI/Pdischarge;notifiesbedsidenurseandPSCwhenorderscompleted,23,方案实施,Individual1-1communicationbyPharmDtoorderingresidentandRNcoordinator.Communicationsenttoallattendingphysicians,notingthattheyareaccountabletoreviewresidentsdischargeordersandwillbenotifiediferrorsarefoundbypharmacists.,24,多边合作,25,再检查,PharmDreportserrors(nearmiss)usingeventreportingprocessNotifiedPM75,1195-9,28,患者再入院率,29,临床药学对医疗质量的影响,PhysiciansrequestittobeappliedtoallourpatientsImprovedpatientsatisfactionImprovedcustomerserviceReducedreadmissionrateby47%(5.7%vs10.2%),30,经济分析,HCMChasapproximately1850SNFdischargesperyear;witheachpatient,medicationreconciliationtakesonaverage24minutesinmind,thisequivalentto700hoursclinicalpharmacytimeannually.PharmaciststohelpwithmedicationreconciliationintheemergencyroomMedicationsafetymanager,31,药事管理,Costtoincreasestaffing$112,000Reductioninexpenses$587,000(ReducedReadmissionsby47%)TheUSpaymentsystemisintransitionfromafeeforservicetopayforperformance.ImprovedQualityforthePatient,32,InstituteforSafeMedicationPractices2010CheersAward,33,TheJointCommissionNationalPatientSafetyGoals国家认证,“theNPSGonreconcilingmedicationinformation(originallyNPSG.08.01.01,butnowNPSG.03.06.01)wasstreamlinedandfocusedtoplaceaspotlightoncriticalriskpointsinthemedicationreconciliationprocess.NPSG.03.06.01iseffectiveJuly1,2011”.,/assets/1/18/National_Patient_Safety_Goals_6_3_111.PDF,34,小结,Needforachange-IdentifytheproblemMeansforachange-Executivecommittee(budgetandsupport)-Actionplanandmodification(PDSA)Teamforachange-multidisciplinaryteam(MD,RN,RPhSocialServiceandclinicalclerks),35,临床药学小结,ClinicalPharmacistsinvolvementinateambasedmodelRealtimefeedbackEmpoweringfrontlinestafftosuggestandenactsolutionsStandardizingworkandprocesses,36,广而告之,ISMP-CanadaNCPDPNAPHIHINQFCMSAJHP,LuY.CliffordP,BjornebyA,ThompsonB,VanNormanS,WonK,LarsenK,QualityImpr