美国药师药学实践-

美国药师药学实践北京大学第三医院药剂科杨丽2023/12/111ASHP对药师的定义

药师的任务是提供药学保健，药学保健是直接、负责地提供与药物治疗相关的保健，其目的是达到改善病人生命质量的确切效果。

2023/12/112北京大学第三医院药剂科美国药师的资格具有Pharm.D.学位通过全美药师资格统一考试通过当地法律考试取得药师执照直接工作or

住院药师培训PharmacyResidencyProgram2023/12/113工作内容药学院教师营养支持药师社区药房药师 肿瘤专科药师普通制剂手术室药师重症监护药师儿科专科药师药物信息药房经营管理医院药房药师毒物控制专科药师医院临床药师零售药店药师传染疾病药师精神专科药师养老院药师公共卫生服务药学管理普通药师部队医院药师兽医药师核医学专科药师2023/12/114北京大学第三医院药剂科药师着装－职业化职业服装－白大褂整洁、干净有利于控制交叉感染不允许穿便服和便鞋必须佩戴标明药师姓名和医疗级别的身份牌提高药师职业形象增加患者的信任感2023/12/115北京大学第三医院药剂科药学服务的沿革PharmaceuticalCarePatientCareProcess I.患者评估

PatientAssessment

II.监护计划

Careplandevelopment III.随访评估

Follow-upevaluation2023/12/116北京大学第三医院药剂科PatientCareProcess

Buildarelationship!自我介绍简述谈话目的轻松气氛了解患者所需期望,治疗目标,顾虑谈话技巧开放式提问鼓励倾听总结“早上好！李先生。我姓杨，是主管你的住院药师。我需要向您了解一些信息，以便更清楚地了解您的情况。您不介意我问一些问题吧？”2023/12/117北京大学第三医院药剂科I.患者评估PatientAssessment 1.收集相关信息

2.评估药物治疗相关需求 3.确定药物治疗问题

文件记录PharmacotherapyWorkup®Notes所有病史及用药史信息被归纳入一个结构化的表格中！2023/12/118北京大学第三医院药剂科PharmacotherapyWorkup©notes-ASSESSMENTpatientreasonforencounter:CONTACTINFORMATIONNameAddressCityStatePostalCodeTelephone(h)(w)(cell)e-mailPharmacyNameClinicName(tel)(tel)DEMOGRAPHICSAgeDateofBirthGender:M/FWeightHeightLeanBodyWeightPregnancystatus:Y/NBreastFeeding:Y/NDueDateOccupationLivingArrangements/FamilyHealthInsurance(coverageissues):2023/12/119北京大学第三医院药剂科SOCIALDRUGUSESubstanceHistoryofUseSubstanceHistoryofUseTobacco__Notobaccouse__0-1packsperday__>1packsperday__previoushistoryofsmoking__attemptstoquitAlcohol__Noalcoholuse__1-2drinksperweek__3-6drinksperweek__>6drinksperweek__historyofalcoholdependenceCaffeine__Nocaffeineuse__<2cupsperday__2-6cupsperday__>6cupsperday__historyofcaffeinedependenceOtherrecreationalDruguseALLERGIES&ALERTSMedicationAllergies(drug,timing,reaction--rash,SOB,angioedema,anaphylaxis)Adversereactionstodrugsinthepast(Intolerances)OtherAlerts/HealthAids/SpecialNeeds(sight,hearing,mobility,literacy,disability)2023/12/1110北京大学第三医院药剂科CURRENTMEDIALCONDITIONS

ANDMEDICATIONSIndicationDrugProductDosageRegimendose,route,frequency,durationStartDateResponseeffectiveness/safetyPAST

DRUGTHERAPIESIndicationDrugTherapyResponseDate2023/12/1111北京大学第三医院药剂科PASTMEDICALHISTORY(relevantillnesses,hospitalization,surgicalprocedures,injuries,pregnancies,deliveries)PHARMACIST’SOBSERVATIONS(MEDICATIONEXPERIENCE)Whatisthepatient’sgeneralattitudetowardtakingmedication?NeedsattentionincareplanYNWhatdoesthepatientwant/expectfromhis/herdrugtherapy?NeedsattentionincareplanYNWhatconcernsdoesthepatienthavewithhis/hermedications?NeedsattentionincareplanYNTowhatextentdoesthepatientunderstandhis/hermedications?NeedsattentionincareplanYNAretherecultural,religious,orethicalissuesthatinfluencethepatient’swillingnesstotakemedications?NeedsattentionincareplanYNVitalSignsBP_______/_______HR_______bpmRespRate_______Temp_______2023/12/1112北京大学第三医院药剂科reviewofsystemsGeneralSystemsPoorappetite

GU/ReproductiveDysmenorrhea/menstrualbleedingWeightchangePainIncontinenceHeadacheImpotenceDizziness(vertigo)DecreasedsexualdriveEENTChangeinvisionVaginaldischargeoritchingLossofhearingHotflashesRingingintheears(tinnitus)Kidney/UrinaryUrinaryfrequencyBloodynose(epistaxis)Bloodyurine(hematuria)AllergicrhinitisRenaldysfunctionGlaucomaHematopoieticSymptomsExcessivebruisingBloodysputum(hemoptysis)BleedingCardiovascularChestpainAnemiaHyperlipidemiaMusculoskeletalBackpainHypertensionArthritispain(osteo/rheumatoid)MyocardialInfarctionOrthostatichypotensionTendonitisPulmonaryAsthmaPainfulmusclesShortnessofbreathNeuropsychiatricNumb,tinglingsensationinextremities(parasthesia)WheezingGastrointestinalHeartburnAbdominalpainTremorNauseaLossofbalanceVomitingDepressionDiarrheaSuicidalConstipationAnxiety,nervousnessSkinEczema/PsoriasisInabilitytoconcentrateItching(pruritis)SeizureRashStroke/TIAEndocrineSystemsDiabetesMemorylossHypothyroidismInfectiousDiseaseHIV/AIDSMenopausalSymptomsMalariaHepaticCirrhosisSyphilisHepatitisGonorrheaNutrition/Fluid/ElectrolytesDehydrationHerpesEdemaChlamydiaPotassiumdeficiencyTuberculosis2023/12/1113北京大学第三医院药剂科DrugTherapyProblemIdentification/Characterization

drugtherapyproblemsmedicalconditionanddrugtherapyinvolvedindicationUnnecessaryDrugTherapy__Nomedicalindication__Duplicatetherapy__Nondrugtherapyindicated__TreatingavoidableADR__Addictive/recreationalNeedsAdditionalDrugTherapy__Untreatedcondition__Preventative/prophylactic__Synergistic/potentiatingmedicalconditionanddrugtherapyinvolvedeffectivenessNeedsDifferentDrugProduct__Moreeffectivedrugavailable__Conditionrefractorytodrug__Dosageforminappropriate__NoteffectiveforconditionDosagetoolow__Wrongdose__Frequencyinappropriate__Druginteraction__DurationinappropriatemedicalconditionanddrugtherapyinvolvedsafetyAdverseDrugReaction__Undesirableeffect__Unsafedrugforpatient__Druginteraction__Dosageadministeredorchangedtoorapidly__Allergicreaction__ContraindicationspresentDosageTooHigh__Wrongdose__Frequencyinappropriate__Durationinappropriate__Druginteraction__IncorrectadministrationmedicalconditionanddrugtherapyinvolvedcomplianceNoncompliance__Directionsnotunderstood__Patientprefersnottotake__Patientforgetstotake__Drugproducttooexpensive__Cannotswallow/administer__Drugproductnotavailable2023/12/1114北京大学第三医院药剂科II.监护计划

CareplandevelopmentPharmacotherapyWorkup©notesCAREPLANINDICATION(medicalcondition)HISTORYOFTHEPRESENTILLNESSORMEDICALCONDITION(includingpreviousapproachestotreatmentandresponses)GOALSOFTHERAPY(improvementornormalizationofsigns/symptoms/laboratorytestsorreductionofrisk)1.2.DRUGTHERAPYPROBLEMStoberesolved

_____NoneatthistimeTherapeuticAlternatives(toresolvethedrugtherapyproblemandrationale)1.2.2023/12/1115北京大学第三医院药剂科PHARMACOTHERAPYPLAN(includescurrentdrugtherapiesandchangesbasedonbesttherapeuticalternativechoicefromabove)medications(drugproducts)dosageinstructions(dose,route,frequency,duration)noteschangesOtherinterventionstooptimizedrugtherapy:Scheduleforfollow-upevaluation:2023/12/1116北京大学第三医院药剂科III.随访评估

Follow-upevaluationPharmacotherapyWorkup©notesFOLLOW-UPEVALUATIONMedicalCondition(Indication):______________________________________OutcomeParameterPretreatmentBaseline(Date)FirstFollow-up(Date)SecondFollow-up(Date)EffectivenessSign/symptomSign/symptomLabvalueLabvalueSafetySign/symptomSign/symptomLabvalueLabvalueOther2023/12/1117北京大学第三医院药剂科statusSTATUSInitial:goalsbeingestablished,initiatenewtherapyResolve:goalsachieved,therapycompletedStable:goalsachieved,continuesametherapyImproved:adequateprogressbeingmade,continuesametherapyPartialImprovement:progressbeingmade,adjustmentsintherapyrequiredUnimproved:noprogressyet,continuesametherapyWorsened:declineinhealth,adjusttherapyFailure:goalsnotachieved,discontinuecurrenttherapyandreplacewithdifferenttherapyNewDrugTherapyProblemsIdentified__noneatthistime__documented__noneatthistime__documentedDateSchedulefornextfollow-upCommentsSignature___________________________Date_______________2023/12/1118北京大学第三医院药剂科ExcellenceInProgress2005Rankings:CollegesofPharmacy

RANK

Assessmentscore(5.0)1.UniversityofCalifornia--SanFrancisco4.62. UniversityofTexas--Austin 4.43. UniversityofNorthCarolina--ChapelHill4.24. PurdueUniversity 4.1UniversityofArizona 4.1UniversityofMichigan–AnnArbor 4.1UniversityofMinnesota–TwinCities 4.18. UniversityofKentucky 4.0UniversityofIllinois–Chicago 4.0UniversityofMaryland–Baltimore 4.02023/12/1119北京大学第三医院药剂科临床药学实践内容医院药学实践HospitalPharmacyPractice特殊患者药学服务SpecialtyPopulationPractice药师门诊实践AmbulatoryCarePractice社区药学实践CommunityPharmacyPractice零售药店R