對(duì)臨床藥學(xué)焦點(diǎn)問(wèn)題的認(rèn)識(shí)課件

1、對(duì)臨床藥學(xué)焦點(diǎn)問(wèn)題的認(rèn)識(shí)邵 宏北京大學(xué)藥學(xué)院藥事管理與臨床藥學(xué)系A(chǔ)CCP (American College of Clinical Pharmacy). accp, 2019主要焦點(diǎn)問(wèn)題如何理解臨床藥學(xué)和藥師的內(nèi)涵？何為臨床藥學(xué)？Clinical Pharmacy臨床(clinical)的概念【美國(guó)傳統(tǒng)詞典】Involving or based on direct observation of the patient【高級(jí)漢語(yǔ)詞典】接觸病人，診治疾病ACCP和ESCP的權(quán)威定義形式 藥學(xué)實(shí)踐(Pharmacy Practice)Clinical Pharmacy is a commonly

2、used term in pharmacy practice and in pharmacy literature核心 合理用藥the activities and services of the clinical pharmacist to develop and promote the rational and appropriate use of medicinal products and devices使命與患者基本需求 藥學(xué)監(jiān)護(hù)(Pharmaceutical Care)necessary philosophy and mission of pharmacy practice, a

3、basic patient need歷史地位：Revolution or Renaissance ?臨床藥學(xué)是醫(yī)療發(fā)展的必然結(jié)果先進(jìn)(美國(guó))發(fā)達(dá)(歐澳日)發(fā)展中(中國(guó))初期落后藥師職業(yè)與國(guó)家臨床藥學(xué)水平美國(guó)藥學(xué)院校教學(xué)重心轉(zhuǎn)移何為臨床藥師？Clinical Pharmacist臨床藥師是為患者提供藥學(xué)服務(wù)的藥學(xué)專(zhuān)家（Pharmacy Specialist）美國(guó)藥學(xué)人員的分類(lèi)Pharmacist (Pharmacy specialist, Clinical Pharmacist)Pharmacy technician臨床藥師相關(guān)問(wèn)題 Part or Full ？ FTE Pharmacists

4、(Full Time Equivalent，40 hrs/w) 臨床藥師的數(shù)量、學(xué)位和社會(huì)地位臨床藥師的數(shù)量國(guó)家醫(yī)院床位臨床藥師數(shù)床位/臨床藥師美國(guó)ASHP 2019年肯塔基大學(xué)醫(yī)學(xué)中心馬薩諸塞大學(xué)醫(yī)學(xué)中心康涅狄格大學(xué)Hartford醫(yī)院4733501006平均9.81112217平均84.31660英國(guó)Withybush General HospitalAshford and St Peters HospitalOxford Radcliffe Hospitals2956931100112335133048澳大利亞Canberra HospitalRoyal Darwin HospitalR

5、oyal Perth HospitalPrince of Wales HospitalFrankston Hospital500363855700336小醫(yī)院23大醫(yī)院4050平均12臺(tái)灣臺(tái)北新光吳火獅紀(jì)念醫(yī)院長(zhǎng)庚紀(jì)念醫(yī)院林口分院臺(tái)中林新醫(yī)院高雄基督教信義醫(yī)院1000340040010010280205100122025北醫(yī)三院1187？(20)60臨床藥師的學(xué)位MONEY Magazine 2019 Career SurveyPharmacists 9/50Stress: BFlexibility: CCreativity: BDifficulty: CTen Year Growth:24.

6、5%Average Pay:$91,988主要焦點(diǎn)問(wèn)題如何理解臨床藥學(xué)和藥師的內(nèi)涵？臨床藥師為誰(shuí)而工作？如何工作？工作對(duì)象：醫(yī)生 or 患者？工作環(huán)境：個(gè)人 or 群體？PhysiciansAttendingFellowResidentInternMedical studentPhysician assistant & Nurse practitionerNursing StaffPharmacistsPharmacy SpecialistPreceptor, Advisor & ResidentInstructor & Pharm.D. studentDieticiansHousekeepe

7、rsEthics CommitteeHealth Care Team工作性質(zhì)：監(jiān)管 or 服務(wù)？工作手段鑒別、解決、預(yù)防潛在的或?qū)嶋H發(fā)生的DRPsTypes of Drug-Related Problems工作步驟通過(guò)PWDT完成一個(gè)具體的服務(wù)項(xiàng)目PWDT Pharmacists Workup of Drug Therapy工作目的通過(guò)藥物治療達(dá)到預(yù)定療效來(lái)改善患者生命質(zhì)量主要焦點(diǎn)問(wèn)題如何理解臨床藥學(xué)和藥師的內(nèi)涵？臨床藥師為誰(shuí)而工作？如何工作？臨床藥師主要干什么？藥師職業(yè)角色的發(fā)展藥學(xué)實(shí)踐Pharmacy PracticePharmaceutical CareSelf-CareDrug Inf

8、ormationClinicalDistributive溝通技巧藥學(xué)實(shí)踐的模式為促進(jìn)健康和預(yù)防疾病準(zhǔn)備教育材料利用分析技術(shù)影響藥物利用和藥物利用策略具有健康篩查和診斷的技巧，藥物治療方案的設(shè)計(jì)與推介，治療方案的判別藥物治療方案的設(shè)計(jì)、推介、監(jiān)測(cè)和評(píng)估藥物治療方案的設(shè)計(jì)、推介、監(jiān)測(cè)和評(píng)估利用高級(jí)溝通技巧與患者形成合作關(guān)系并參與醫(yī)療團(tuán)隊(duì)的決策工作的重心由解決用藥相關(guān)問(wèn)題轉(zhuǎn)移到關(guān)注患者生存質(zhì)量具有藥品準(zhǔn)備與分發(fā)的技巧Nimmo CM and Holland RW. AJHP 2019; 56:1981-7Total Pharmacy Care (TPC)工作的主要內(nèi)容藥學(xué)實(shí)踐Pharmacy Pra

9、ctice課堂學(xué)習(xí)與科研活動(dòng)Scholarly Activities對(duì)醫(yī)務(wù)人員和病人及其家屬進(jìn)行教育，講座與宣傳等Scholarly Activities主要內(nèi)容Medical Library and ResourcesMedication HistoriesAnemia Protocol, Intensive Insulin, SedationPediatric OverviewPharmacokinetic ServicesIV Compounding /Sterile TechniquesNutrition Support ServicesPharmacistCare Diabetes

10、ClassPharmacistCare Cardiovascular ClassAnticoagulation clinicPharmacy AdministrationSTLC (Scholarship of Teaching & Learning Certificate Program)理論課學(xué)習(xí)Scholarly ActivitiesCritically Ill Patients Colonized with Multidrug Resistant Organisms and Impact on Length of StayDo positive surveillance culture

11、s predict clinical cultures in the ICU?The Effects of Basiliximab Induction on Serum Creatinine and Time to Calcineurin Inhibitor Initiation in Liver Transplant RecipientsAntibiotic Exposure in Critically Ill Patients Colonized with Multidrug Resistant OrganismsImpact of Medication Therapy Managemen

12、t Services in a Chain Pharmacy Setting on the Pharmacy Business and Dispensing ModelEvaluation of Continuation of Stress Ulcer Prophylaxis at Hospital DischargeEvaluating Bleeding Events in Patients Receiving Activated Protein CEvaluation of a Clinical Scoring Scale (4Ts) for the Diagnosis of Hepari

13、n-Induced ThrombocytopeniaA Clinical Pharmacists Guide to USP Joint Commission Core Measures and Standards: The Pharmacists RoleHemetologic Emergencies - Spinal Cord CompressionWarfarin CYP2C9 and VKORC1 Genetic TestingRenal Cell Cancer- Targeted Therapy BreakthroughThe Use of rFVIIa in Patients Wit

14、h Diffuse Alveolar Hemorrhage Following Bone Marrow TransplantA case study.thinking outside the box!Mycobacterium a rapidly growing problem, or is it?Exjade in the treatment of beta thalassemia major科學(xué)研究工作的主要內(nèi)容藥學(xué)實(shí)踐Pharmacy Practice課堂學(xué)習(xí)與科研活動(dòng)Scholarly Activities對(duì)醫(yī)務(wù)人員和病人及其家屬進(jìn)行教育，講座與宣傳等Points of Pharmac

15、y Practice查房前更新藥歷 Patient Profile & SOAPPatient ProfileSOAPSubjective 患者主訴Objective 體檢信息Objective 體檢信息Objective 體檢信息Objective 體檢信息Objective 體檢信息Objective 體檢信息Assessment 評(píng)估Plan 治療方案Points of Pharmacy Practice查房前更新藥歷 Patient Profile & SOAP隨治療團(tuán)隊(duì)常規(guī)查房 并進(jìn)行病例討論Round WorksheetNeurosurgery ICU RoundPulmonary

16、 ICU RoundCardiology RoundPoints of Pharmacy Practice查房前更新藥歷 Patient Profile & SOAP隨治療團(tuán)隊(duì)常規(guī)查房 并進(jìn)行病例討論DRPs分析Points of Pharmacy Practice查房前更新藥歷 Patient Profile & SOAP隨治療團(tuán)隊(duì)常規(guī)查房 并進(jìn)行病例討論DRPs分析Worksheet；提供藥物信息和教育WorksheetRoutine WorkPoints of Pharmacy Practice查房前更新藥歷 Patient Profile & SOAP隨治療團(tuán)隊(duì)常規(guī)查房 并進(jìn)行病例討論

17、DRPs分析用藥醫(yī)囑與藥學(xué)服務(wù) Pharmacotherapy WorkupWorksheet；提供藥物信息和教育Pharmacotherapy Workup Pharmacotherapy Workup Pharmacotherapy Workup Points of Pharmacy Practice查房前更新藥歷 Patient Profile & SOAP隨治療團(tuán)隊(duì)常規(guī)查房 并進(jìn)行病例討論DRPs分析用藥醫(yī)囑與藥學(xué)服務(wù) Pharmacotherapy WorkupWorksheet；提供藥物信息和教育主要焦點(diǎn)問(wèn)題如何理解臨床藥學(xué)和藥師的內(nèi)涵？臨床藥師為誰(shuí)而工作？如何工作？臨床藥師主要干

18、什么？臨床藥師都在哪里工作？工作范圍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哪里有用藥的病人哪里就有藥學(xué)實(shí)踐哪里就有臨床藥師藥學(xué)實(shí)踐的主要方向主要焦點(diǎn)問(wèn)題如何理解臨床藥學(xué)和藥師的內(nèi)涵？臨床藥師為誰(shuí)而工作？如何工作？臨床

19、藥師主要干什么？臨床藥師都在哪里工作？臨床藥師的水平如何分出高下？臨床藥師的工作層次初級(jí)（Fundamental）在對(duì)病人提供安全的藥學(xué)監(jiān)護(hù)中起關(guān)鍵作用18項(xiàng)具體指標(biāo)中級(jí)（Desirable）提供更專(zhuān)業(yè)化和專(zhuān)科化的藥物治療學(xué)服務(wù)13項(xiàng)具體指標(biāo)高級(jí)（Optimal）提供整合的、專(zhuān)業(yè)化的和精細(xì)的專(zhuān)科服務(wù)，旨在通過(guò)最高層次的教學(xué)、研究和藥物治療實(shí)踐活動(dòng)優(yōu)化藥物治療效果12項(xiàng)具體指標(biāo)Rudis MI and Brandl KM. Crit Care Med 2000; 28(11):3747南加州大學(xué)；新墨西哥州大學(xué)每個(gè)等級(jí)都包含了4個(gè)方面的活動(dòng)：clinical, educational, admi

20、nistrative, scholarly2019年美國(guó)臨床藥師工作狀況MacLaren R, Rudis MI, et al. Ann Pharmacother 2019; 40:612-8科羅拉多州大學(xué)；南加州大學(xué) 382個(gè)醫(yī)療機(jī)構(gòu)活動(dòng)比例直接臨床藥學(xué)活動(dòng)62.2個(gè)單位藥師輪轉(zhuǎn)查房時(shí)間4.40.5 d/w工作時(shí)間分配病人監(jiān)護(hù)藥品分配藥品管理教育教學(xué)4326.212.610.97.3初級(jí)臨床工作75的工作日中級(jí)與高級(jí)工作部分進(jìn)行主要焦點(diǎn)問(wèn)題如何理解臨床藥學(xué)和藥師的內(nèi)涵？臨床藥師為誰(shuí)而工作？如何工作？臨床藥師主要干什么？臨床藥師都在哪里工作？臨床藥師的水平如何分出高下？如何保持和提高臨床藥學(xué)工

21、作水平？職業(yè)培訓(xùn)與繼續(xù)教育Continuing Education普通藥師臨床藥學(xué)專(zhuān)業(yè)畢業(yè)生美國(guó)藥師崗位培訓(xùn)ResidencyJob(practice)Residency(10%)PhDPharmDPharmacistAcademic Teacher & ResearcherPharmacy technician (No License)PGY1 (普通培訓(xùn))PGY2 (專(zhuān)科培訓(xùn))Licensed PharmacistBoard certification（有效期6年）BCPS BCOP BCPP BCNSP BCNPHospitalRetail stores (60%)Drug Compan

22、yGovernment50%組織結(jié)構(gòu)AdvisorPreceptorResidentInstructorResidencyExecutiveCommitteeResident Program DirectorChief ResidentBeginning, Quarterly, ExitMonthly or DailyDailyConclusion測(cè)試與評(píng)估Residency Protest for Pharmacokinetics轉(zhuǎn)科職業(yè)培訓(xùn)的評(píng)估內(nèi)容主要焦點(diǎn)問(wèn)題如何理解臨床藥學(xué)和藥師的內(nèi)涵？臨床藥師為誰(shuí)而工作？如何工作？臨床藥師主要干什么？臨床藥師都在哪里工作？臨床藥師的水平如何分出高下？

23、如何保持和提高臨床藥學(xué)工作水平？行業(yè)協(xié)會(huì)能為臨床藥學(xué)做些什么？行業(yè)協(xié)會(huì)與藥師的認(rèn)證評(píng)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 (1

24、937)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 (2019) ESCP Eur