1. 1 experts specify the depth. Pharmacists who began to undertake in-depth clinical work chose 1 or two clinical specialties as designated departments, and insisted on participating in weekly chief rounds, consultations inside and outside the hospital, medical record analysis and discussion, teaching and other professional activities for 6 months to 1 year; Read the medical records, write the medication calendar of typical cases, and consult the records of medication and treatment orders; Investigate and analyze the situation of drug use in specialized departments, collect and feedback relevant drug use information, understand the characteristics and drug use rules of specialized diseases, and assist specialized departments in rational drug use.
1.2 Generally, the non-designated responsible departments shall be clearly defined on a regular basis. Except when the departments need clinical pharmacists to participate in the work, they shall conduct regular and thorough investigations every week, consult drug treatment records and doctor's orders, read key medical records, understand the medication situation of critically ill patients, solicit opinions and coordinate the disposal.
1.3 Focus on going deep into various departments before holidays. Clinical pharmacists should plan to go deep into departments before holidays, check the therapeutic drugs used by monitored patients, adjust the treatment plan when necessary, and coordinate the preparation of emergency drugs.
1.4 After the clinical pharmacists who participated in the clinical rescue consultation received the consultation notice from the medical department or specialty, the hospital consultation was in place on time (notice), and the first aid consultation was in place within 10 minutes, and the general consultation was completed on the same day. Inviting clinical pharmacists to consult outside the hospital should be completed on the same day or the next day after being approved and notified by the medical department of our hospital. The pharmacist's duty is to provide a rescue medication plan, which can only be implemented after discussion and approval by the consultation group.
1.5 to formulate an individualized drug administration plan. By participating in rounds, consultations, drug concentration monitoring in vivo, etc., participate in the formulation of individualized drug administration plans for typical cases, and assist in the implementation, modification and evaluation of the plans. According to the condition, pathophysiology, pharmacological effect, etiology and biochemical test data.
1.6 pharmaceutical care for key cases For key cases in which pharmacists participate in consultation and rescue or provide individualized medication plans, they must go to the ward every day or every other day according to the cases to directly monitor the patients and observe their condition changes, drug efficacy and adverse reactions. Read the medical records and treatment records carefully, evaluate the curative effect, put forward suggestions for modifying the medication plan when necessary, and then end the key pharmaceutical care until the condition is stable, complete the individualized treatment plan and transfer to the specialist routine treatment.
1.7 Interpretation and utilization of monitoring results of therapeutic drugs in vivo (TDM) Clinical pharmacists should generally report the monitoring results of therapeutic drugs in the laboratory on the same day, and those who monitor and reach the concentration of toxic drugs in an emergency should notify the relevant departments within 10 minutes after obtaining the results. Pharmacists of key cases should interpret the clinical data in depth, and cases that need to be adjusted in medication plan should carefully consult the medical records and observe the condition, and cooperate with the attending doctor to modify the medication plan.
1.8 ADR monitoring is an important part of pharmacists' in-depth clinical work. The division of labor is mainly responsible for pharmacists' in-depth clinical understanding and collection of ADR at least/kloc-0 times a week, assisting clinical prevention of ADR cases, and should fully participate in treatment and disposal. After analyzing, sorting out and counting the causality of the collected ADR reports, the ADR monitoring center of the whole army reported them on time, and timely fed back the ADR related information to the clinic.
1.9 clinical observation of new drugs pharmacists should go deep into the clinic, observe the efficacy and adverse reactions of new drugs used in our hospital and under clinical observation, ensure the safety and effectiveness of clinical medication, and feed back the collected data to relevant departments.
1. 10 pharmaceutical consulting pharmacists go deep into the clinic and undertake medication consulting services provided by doctors, nurses and patients. Emergency drug consultation should be answered immediately or as soon as possible, and general drug consultation 1 ~ 3 days. Organize seminars or lectures on drug use in a planned way to improve the level of clinical rational drug use.
2 The effect and significance of pharmacists' in-depth clinical practice
2. 1 is conducive to clinical diagnosis and correct diagnosis of diseases, and is the premise of effective treatment. The in-depth clinical practice of pharmacists in our hospital for many years has proved that there have been many difficult and serious cases, which were correctly diagnosed because of the participation of pharmacists, such as penetrating epilepsy after brain injury 1 case, brain X-ray knife surgery with poor drug efficacy, and routine use of phenytoin sodium after operation. Seven days after operation, he developed mental symptoms and could not sit up and walk. After consultation with experts inside and outside the hospital, the patient was diagnosed as mental disorder after X-ray knife surgery, and it is planned to let the patient leave the hospital to continue taking medicine. Pharmacists found this situation deeply in clinic, and suggested that the factors of phenytoin poisoning should be excluded when diagnosing this case. After blood sample monitoring, the plasma concentration of phenytoin was 77. 1μg/ml (the normal value was 10 ~ 20 μ g/ml), which proved that phenytoin was an acute poisoning. After reducing the dose, the blood drug gradually fell to the normal range, and the poisoning symptoms were relieved. The patient was diagnosed as phenytoin poisoning after X-ray knife surgery for epilepsy and walked normally when he was discharged from hospital.
2.2 Formulation and Practice of Individualized Medication Scheme The key to improving the curative effect is to use drugs according to objective factors such as the physiological and pathological conditions of the recipients and individual pharmacokinetic parameters. According to the monitoring results of smelting drugs in vivo or the pharmacokinetic parameter formula of simulated population, pharmacists provide targeted medication schemes for some drugs with low drug safety index and large individual differences, as well as liver and kidney function. For example, 1 critical patients with multiple fractures, traumatic shock and pulmonary infection have body temperatures above 39℃. The clinical results showed that WBC20× 109/L, BUN36.3mmol/L, Cr 610 μ mol/L. Anti-infection is one of the important measures to treat this case, but the renal function is seriously damaged and it is difficult to use drugs. According to the observation of the disease and the analysis of the results of related biochemical tests, the pharmacist calculated the drug dosage according to the renal function, provided ceftazidime 0.75g, 1 time/12 h intravenous drip administration scheme, and adjusted the dosage with the change of renal function test results. The infection was controlled, the renal function returned to normal, and the patient was cured and discharged.
2.3 contribute to the successful treatment of critically ill patients. Clinical pharmacists insist on being on call, participating in and assisting in the treatment at the rescue site, and their main duties are to provide relevant treatment measures and use drugs reasonably in the treatment. For example, a male aged 1 74 took more than 30 tablets of digoxin (0.25mg/ tablet) by mistake at one time, and the blood concentration was as high as 20.5 1ng/ml (normal 0.5 ~ 2ng/ml). After 24 hours of routine clinical treatment, the blood drug concentration is still as high as 19.49ng/ml, with little effect. Eliminating poisons in the body as soon as possible is an important principle for pharmacists to treat ECG ⅱ 0 atrioventricular block, and the half-life of digoxin is 32 ~ 48 hours. Hemoperfusion under the monitoring of therapeutic drugs (TDM-HP) was proposed and adopted after negotiation. After 2.5h hours of carbon kidney perfusion, the drug for TDM blood test decreased from 19.49ng/ml to 10.88ng/ml, which proved that the time of HP-TDM regimen was only110 of the conventional method, and the curative effect was improved.
2.4 Adverse Drug Reaction Monitoring The ultimate goal of preventing and reducing adverse drug reactions is to ensure the effectiveness, safety, convenience and economy of people's medication. Pharmacists can find, judge and collect ADR cases in time by going deep into the clinic. At the same time, they attach importance to assisting in clinical prevention of ADR. Once serious ADR occurs, it should be handled properly in time to reduce the occurrence of ADR and the severity of ADR symptoms. In the treatment of 1 case of rare multi-bacterial gangrene of both upper limbs, pharmacists not only assisted in providing reasonable and effective medication scheme, but also worked out specific measures to prevent and reduce ADR with medical care. During several months of intermittent anti-infection treatment, the patients' liver and kidney functions remained normal all the time, and no obvious ADR occurred, which protected the patients' health and ensured the treatment scheme. The measures to prevent adverse drug reactions are effective and ensure the rarity of this case.
2.5 Pharmacists go deep into clinical practice, keep close relationship with doctors, nurses and patients, and increase mutual understanding and support. * * * Patient-centered cooperation is conducive to the improvement of treatment quality and overall medical level.
2.6 Improve the scientific rationality of drug supply, management and use in hospitals. Pharmacists went deep into the clinic, put forward specialized essential drugs after investigation and full consultation, and participated in the formulation of our hospital's essential drugs catalogue, which was divided into (1, 2,3) supply, classified (A, B, C) management and microcomputer system control, so that the supply, management and use of drugs in the hospital entered a scientific track.
2.7 Save medical and health expenses Pharmacists go deep into the clinic and directly serve patients, which strengthens the pertinence of medication, improves the success rate of treatment and reduces the occurrence of adverse reactions, which is not only reflected in the improvement of medical quality, but also saves and reduces medical and health expenses. For example, in the consultation of 1 patient with septic septicemia, acute suppurative osteomyelitis and toxic shock, the condition of norvancomycin-fosfomycin provided by pharmacists was quickly relieved after being adopted, and compared with the original scheme, the daily drug cost was saved by 6 1 1.73 yuan.
2.8 Promote the cultivation and improvement of pharmaceutical professionals, and promote the development of hospital pharmacy. Carry out clinical pharmacy. Pharmacists' in-depth clinical and pharmaceutical services will promote the transformation of hospital pharmacists' functions and work scope, and improve the quality and service demand of pharmaceutical Yamatonokusushi. Hospital pharmacy will strengthen the construction of clinical pharmacy specialty and speed up the cultivation of professional talents, so as to meet the requirements of modern hospital development for Yamatonokusushi level of pharmacy specialty.
3. Insist on pharmacists going deep into clinical practice to promote the progress and deepening of clinical pharmacy.
Clinical pharmacy and pharmaceutical service are the development direction of hospital pharmacy. Compared with developed countries, clinical pharmacy in China is still far behind, with unbalanced development and two problems of popularization and improvement. Rational drug use is a social health and medical system engineering. At present, it is difficult to carry out clinical pharmacy work, especially the problem of pharmacists going deep into clinic. In addition to attaching importance to and strengthening the continuing education of existing in-service pharmacists, efforts should be made to speed up the training of high-quality pharmaceutical professionals and senior clinical pharmacists, and necessary working conditions should be given. Relevant state departments should strengthen leadership, formulate domestic standards for clinical pharmacy and clinical pharmacists, and clarify responsibilities, rights and obligations. It is emphasized that pharmacists must go deep into the clinic, participate in drug decision-making and provide pharmaceutical services for patients, so as to promote the rapid popularization and deepening of clinical pharmacy in China.