美国药师药学实践-.ppt

美国美国药师药学学实践践北京大学第三医院北京大学第三医院药剂科科杨 丽2024/4/22 2024/4/22 周一周一1 1ASHP对药师的定的定义 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。2024/4/22 2024/4/22 周一周一2 2北京大学第三医院药剂科北京大学第三医院药剂科美国美国药师的的资格格n n具有具有 Pharm.D.学位学位n n通通过全美全美药师资格格统一考一考试n n通通过当地法律考当地法律考试n n取得取得药师执照照直接工作直接工作 or 住院住院药师培培训Pharmacy Residency Program2024/4/22 2024/4/22 周一周一3 3工作内容工作内容药药学院教学院教学院教学院教师师营营养支持养支持养支持养支持药师药师社区社区社区社区药药房房房房药师药师肿肿瘤瘤瘤瘤专专科科科科药师药师普通制普通制普通制普通制剂剂手手手手术术室室室室药师药师重症重症重症重症监护药师监护药师儿科儿科儿科儿科专专科科科科药师药师药药物信息物信息物信息物信息药药房房房房经营经营管理管理管理管理医院医院医院医院药药房房房房药师药师毒物控制毒物控制毒物控制毒物控制专专科科科科药师药师医院医院医院医院临临床床床床药师药师零售零售零售零售药药店店店店药师药师传传染疾病染疾病染疾病染疾病药师药师 精神精神精神精神专专科科科科药师药师养老院养老院养老院养老院药师药师 公共公共公共公共卫卫生服生服生服生服务务药药学管理学管理学管理学管理 普通普通普通普通药师药师部部部部队队医院医院医院医院药师药师兽兽医医医医药师药师核医学核医学核医学核医学专专科科科科药师药师2024/4/22 2024/4/22 周一周一4 4北京大学第三医院药剂科北京大学第三医院药剂科药师着装着装职业化化n n职业服装白大褂服装白大褂n n整整洁、干、干净l l有利于控制交叉感染有利于控制交叉感染有利于控制交叉感染有利于控制交叉感染n n不允不允许穿便服和便鞋穿便服和便鞋n n必必须佩戴佩戴标明明药师姓名和医姓名和医疗级别的身份牌的身份牌提高提高药师职业形象形象增加患者的信任感增加患者的信任感2024/4/22 2024/4/22 周一周一5 5北京大学第三医院药剂科北京大学第三医院药剂科药学服学服务的沿革的沿革Pharmaceutical CarePatient Care ProcessI.患者患者评估估 Patient AssessmentII.监护计划划 Care plan developmentIII.随随访评估估 Follow-up evaluation2024/4/22 2024/4/22 周一周一6 6北京大学第三医院药剂科北京大学第三医院药剂科Patient Care ProcessBuild a relationshipBuild a relationship!自我介自我介绍 简述述谈话目的目的 轻松气氛松气氛 了解患者所需了解患者所需 期望期望期望期望,治治治治疗疗目目目目标标,顾虑顾虑 谈话技巧技巧 开放式提开放式提开放式提开放式提问问 鼓励鼓励鼓励鼓励 倾倾听听听听 总结总结“早上好！李先生。我姓早上好！李先生。我姓杨，是主管你的住院是主管你的住院药师。我需。我需要向您了解一些信息，以便要向您了解一些信息，以便更清楚地了解您的情况。您更清楚地了解您的情况。您不介意我不介意我问一些一些问题吧？吧？”2024/4/22 2024/4/22 周一周一7 7北京大学第三医院药剂科北京大学第三医院药剂科I.患者患者评估估 Patient Assessment1.1.收集相关信息收集相关信息收集相关信息收集相关信息 2.2.评评估估估估药药物治物治物治物治疗疗相关需求相关需求相关需求相关需求3.3.确定确定确定确定药药物治物治物治物治疗问题疗问题文件文件记录Pharmacotherapy Workup NotesPharmacotherapy Workup Notes所有病史及用所有病史及用药史信息被史信息被归纳入一个入一个结构化的表格中！构化的表格中！2024/4/22 2024/4/22 周一周一8 8北京大学第三医院药剂科北京大学第三医院药剂科Pharmacotherapy Workup notes -ASSESSMENTPharmacotherapy Workup notes -ASSESSMENTpatient reason for encounter:patient reason for encounter:C COON NT TA AC CT T I IN NF FOOR RMMA AT TI IOON NNameNameAddressAddressCityCityStateStatePostal CodePostal CodeTelephone(h)Telephone(h)(w)(w)(cell)(cell)e-maile-mailPharmacy NamePharmacy NameClinic NameClinic Name(tel)(tel)(tel)(tel)D DE EMMOOGGR RA AP PH HI IC CS SAgeAgeDate of BirthDate of BirthGender:M/FGender:M/FWeightWeightHeightHeightLean Body WeightLean Body WeightPregnancy status:Pregnancy status:Y/NY/NBreast Feeding:Breast Feeding:Y/NY/NDue DateDue DateOccupationOccupationLiving Arrangements/FamilyLiving Arrangements/FamilyHealth Insurance(coverage issues):Health Insurance(coverage issues):2024/4/22 2024/4/22 周一周一9 9北京大学第三医院药剂科北京大学第三医院药剂科S SOOC CI IA AL L D DR RU UGG U US SE ESubstanceSubstanceHistory of UseHistory of UseSubstanceSubstanceHistory of UseHistory of UseTobaccoTobacco_ No tobacco _ No tobacco useuse_ 0-1 packs per day_ 0-1 packs per day_ 1 packs per day_ 1 packs per day_ previous history _ previous history of smokingof smoking_ attempts to quit_ attempts to quit Alcohol Alcohol_ No _ No alcohol alcohol useuse_ 1-2 drinks per _ 1-2 drinks per weekweek_ 3-6 drinks per _ 3-6 drinks per weekweek_ 6 drinks per _ 6 drinks per weekweek_ history of _ history of alcohol alcohol dependencedependenceCaffeineCaffeine_ No caffeine _ No caffeine useuse_ 2 cups per day_ 6 cups per day_ 6 cups per day_ history of caffeine _ history of caffeine dependencedependenceOtherOtherrecreationalrecreationalDrug useDrug useA AL LL LE ER RGGI IE ES S&A AL LE ER RT TS SMedication Allergies(drug,timing,reaction-rash,SOB,Medication Allergies(drug,timing,reaction-rash,SOB,angioedema,anaphylaxis)angioedema,anaphylaxis)Adverse reactions to drugs in the past(Intolerances)Adverse reactions to drugs in the past(Intolerances)Other Alerts/Health Aids/Special Needs(sight,hearing,Other Alerts/Health Aids/Special Needs(sight,hearing,mobility,literacy,disability)mobility,literacy,disability)2024/4/22 2024/4/22 周一周一1010北京大学第三医院药剂科北京大学第三医院药剂科C CU UR RR RE EN NT T MME ED DI IA AL L C COON ND DI IT TI IOON NS S A AN ND D MME ED DI IC CA AT TI IOON NS SIndicationIndicationDrug Drug ProductProductDosage RegimenDosage Regimendose,route,dose,route,frequency,frequency,durationdurationStartStart Date DateResponseResponseeffectiveness/effectiveness/safetysafetyP PA AS ST T D DR RU UGG T TH HE ER RA AP PI IE ES SIndicationIndicationDrug TherapyDrug TherapyResponseResponseDateDate2024/4/22 2024/4/22 周一周一1111北京大学第三医院药剂科北京大学第三医院药剂科PAST MEDICAL HISTORY (relevant illnesses,hospitalization,PAST MEDICAL HISTORY (relevant illnesses,hospitalization,surgical procedures,injuries,pregnancies,deliveries)surgical procedures,injuries,pregnancies,deliveries)P PH HA AR RMMA AC CI IS ST T S S OOB BS SE ER RV VA AT TI IOON NS S(MME ED DI IC CA AT TI IOON N E EX XP PE ER RI IE EN NC CE E)What is the patients general attitude toward What is the patients general attitude toward taking medication?taking medication?Needs attentionNeeds attention in care plan in care planY NY NWhat does the patient want/expect from his/her What does the patient want/expect from his/her drug therapy?drug therapy?Needs attentionNeeds attention in care plan in care planY NY NWhat concerns does the patient have with What concerns does the patient have with his/her medications?his/her medications?Needs attentionNeeds attention in care plan in care planY NY NTo what extent does the patient understand To what extent does the patient understand his/her medications?his/her medications?Needs attention Needs attention in care planin care planY NY NAre there cultural,religious,or ethical issues that Are there cultural,religious,or ethical issues that influence the patients willingness to take influence the patients willingness to take medications?medications?Needs attentionNeeds attention in care plan in care planY NY NVital SignsVital SignsBP_/_ BP_/_ HR _bpm HR _bpm Resp Rate _ Resp Rate _ Temp _Temp _2024/4/22 2024/4/22 周一周一1212北京大学第三医院药剂科北京大学第三医院药剂科r re ev vi ie eww o of f s sy ys st te emms sGeneralGeneralSystemsSystemsPoor appetitePoor appetite GU/ReproductiveGU/ReproductiveDysmenorrhea/menstrualDysmenorrhea/menstrualbleedingbleedingWeight changeWeight changePainPainIncontinenceIncontinenceHeadacheHeadacheImpotenceImpotenceDizziness(vertigo)Dizziness(vertigo)Decreased sexual driveDecreased sexual driveEENTEENTChange in visionChange in visionVaginal discharge or itchingVaginal discharge or itchingLoss of hearingLoss of hearingHot flashesHot flashesRinging in the ears(tinnitus)Ringing in the ears(tinnitus)Kidney/UrinaryKidney/UrinaryUrinary frequencyUrinary frequencyBloody nose(epistaxis)Bloody nose(epistaxis)Bloody urine(hematuria)Bloody urine(hematuria)Allergic rhinitisAllergic rhinitisRenal dysfunctionRenal dysfunctionGlaucomaGlaucomaHematopoieticHematopoieticSymptomsSymptomsExcessive bruisingExcessive bruisingBloody sputum(hemoptysis)Bloody sputum(hemoptysis)BleedingBleedingCardiovascularCardiovascularChest painChest painAnemiaAnemiaHyperlipidemiaHyperlipidemiaMusculoskeletalMusculoskeletalBack painBack painHypertensionHypertensionArthritis painArthritis pain(osteo/rheumatoid)(osteo/rheumatoid)Myocardial InfarctionMyocardial InfarctionOrthostatic hypotensionOrthostatic hypotensionTendonitisTendonitisPulmonaryPulmonaryAsthmaAsthmaPainful musclesPainful musclesShortness of breathShortness of breathNeuropsychiatricNeuropsychiatricNumb,tingling sensationNumb,tingling sensationin extremitiesin extremities(parasthesia)(parasthesia)WheezingWheezingGastrointestinalGastrointestinalHeartburnHeartburnAbdominal painAbdominal painTremorTremorNauseaNauseaLoss of balanceLoss of balanceVomitingVomitingDepressionDepressionDiarrheaDiarrheaSuicidalSuicidalConstipationConstipationAnxiety,nervousnessAnxiety,nervousnessSkinSkinEczema/PsoriasisEczema/PsoriasisInability to concentrateInability to concentrateItching(pruritis)Itching(pruritis)SeizureSeizureRashRashStroke/TIAStroke/TIAEndocrineEndocrineSystemsSystemsDiabetesDiabetesMemory lossMemory lossHypothyroidismHypothyroidismInfectiousInfectiousDiseaseDiseaseHIV/AIDSHIV/AIDSMenopausal SymptomsMenopausal SymptomsMalariaMalariaHepaticHepaticCirrhosisCirrhosisSyphilisSyphilisHepatitisHepatitisGonorrheaGonorrheaNutrition/Fluid/Nutrition/Fluid/ElectrolytesElectrolytesDehydrationDehydrationHerpesHerpesEdemaEdemaChlamydiaChlamydiaPotassium deficiencyPotassium deficiencyTuberculosisTuberculosis2024/4/22 2024/4/22 周一周一1313北京大学第三医院药剂科北京大学第三医院药剂科Drug Therapy Problem Identification/CharacterizationDrug Therapy Problem Identification/Characterization d dr ru ug g t th he er ra ap py y p pr ro ob bl le emms smedical condition and drug therapy involvedmedical condition and drug therapy involvedindicationindicationUnnecessary Drug TherapyUnnecessary Drug Therapy_No medical indication_No medical indication_Duplicate therapy_Duplicate therapy_Nondrug therapy indicated_Nondrug therapy indicated_Treating avoidable ADR_Treating avoidable ADR_Addictive/recreational_Addictive/recreationalNeeds Additional Drug TherapyNeeds Additional Drug Therapy_Untreated condition_Untreated condition_Preventative/prophylactic_Preventative/prophylactic_Synergistic/potentiating_Synergistic/potentiatingmedical condition and drug therapy involvedmedical condition and drug therapy involvedeffectivenesseffectivenessNeeds Different Drug ProductNeeds Different Drug Product_More effective drug available_More effective drug available_Condition refractory to drug_Condition refractory to drug_Dosage form inappropriate_Dosage form inappropriate_Not effective for condition_Not effective for conditionDosage too lowDosage too low_Wrong dose_Wrong dose_Frequency inappropriate_Frequency inappropriate_Drug interaction_Drug interaction_Duration inappropriate_Duration inappropriatemedical condition and drug therapy involvedmedical condition and drug therapy involvedsafetysafetyAdverse Drug ReactionAdverse Drug Reaction_Undesirable effect_Undesirable effect_Unsafe drug for patient_Unsafe drug for patient_Drug interaction_Drug interaction_Dosage administered or changed too rapidly_Dosage administered or changed too rapidly_Allergic reaction_Allergic reaction_Contraindications present_Contraindications presentDosage Too HighDosage Too High_Wrong dose_Wrong dose_Frequency inappropriate_Frequency inappropriate_Duration inappropriate_Duration inappropriate_Drug interaction_Drug interaction_Incorrect administration_Incorrect administrationmedical condition and drug therapy involvedmedical condition and drug therapy involvedcompliancecomplianceNoncomplianceNoncompliance_Directions not understood_Directions not understood_Patient prefers not to take_Patient prefers not to take_Patient forgets to take_Patient forgets to take_Drug product too expensive_Drug product too expensive_Cannot swallow/administer_Cannot swallow/administer_Drug product not available_Drug product not available2024/4/22 2024/4/22 周一周一1414北京大学第三医院药剂科北京大学第三医院药剂科II.监护计划划 Care plan developmentPharmacotherapy Workup notes CARE PLANPharmacotherapy Workup notes CARE PLANINDICATION(medical condition)HISTORY OF THE PRESENT ILLNESS OR MEDICAL CONDITION(including previous approaches to treatment and responses)GOALS OF THERAPY(improvement or normalization of signs/symptoms/laboratory tests or reduction of risk)1.2.DRUG THERAPY PROBLEMS to be resolved _None at this timeTherapeutic Alternatives(to resolve the drug therapy problem and rationale)1.2.2024/4/22 2024/4/22 周一周一1515北京大学第三医院药剂科北京大学第三医院药剂科PHARMACOTHERAPY PLAN(includes current drug therapies and changes based on best therapeutic alternative choice from above)medicationsmedications(drug products)(drug products)dosage instructionsdosage instructions(dose,route,frequency,duration)(dose,route,frequency,duration)notes notes changeschangesOther interventions to optimize drug therapy:Schedule for follow-up evaluation:2024/4/22 2024/4/22 周一周一1616北京大学第三医院药剂科北京大学第三医院药剂科III.随随访评估估 Follow-up evaluationPharmacotherapy Workup notes FOLLOW-UP EVALUATIONPharmacotherapy Workup notes FOLLOW-UP EVALUATIONMedical Condition(Indication):_Medical Condition(Indication):_Outcome ParameterOutcome ParameterPretreatmentPretreatmentBaseline Baseline(Date)(Date)First First Follow-upFollow-up(Date)(Date)Second Second Follow-upFollow-up(Date)(Date)E Ef ff fe ec ct ti iv ve en ne es ss sSign/symptomSign/symptomSign/symptomSign/symptomLab valueLab valueLab valueLab valueS Sa af fe et ty ySign/symptomSign/symptomSign/symptomSign/symptomLab valueLab valueLab valueLab valueOtherOther2024/4/22 2024/4/22 周一周一1717北京大学第三医院药剂科北京大学第三医院药剂科s st ta at tu us sSTATUSSTATUSInitial:Initial:goals being established,initiate new therapy goals being established,initiate new therapyResolveResolve:goals achieved,therapy completed:goals achieved,therapy completedStable:Stable:goals achieved,continue same therapy goals achieved,continue same therapyImproved:Improved:adequate progress being made,continue adequate progress being made,continue same therapysame therapyPartial Improvement:Partial Improvement:progress being made,progress being made,adjustments in therapy requiredadjustments in therapy requiredUnimproved:Unimproved:no progress yet,continue same therapy no progress yet,continue same therapyWorsenedWorsened:decline in health,adjust therapy:decline in health,adjust therapyFailure:Failure:goals not achieved,discontinue current goals not achieved,discontinue current therapy and replace with different therapytherapy and replace with different therapyNew Drug Therapy Problems IdentifiedNew Drug Therapy Problems Identified_none at _none at this timethis time_docume_documentednted_none at _none at this timethis time_docum_documentedentedD Da at te eSchedule for next follow-upSchedule for next follow-upCommentsCommentsSignature_ Date_2024/4/22 2024/4/22 周一周一1818北京大学第三医院药剂科北京大学第三医院药剂科Excellence In Progress2005 Rankings:Colleges of Pharmacy2005 Rankings:Colleges of PharmacyRANK RANK Assessment score(5.0)Assessment score(5.0)1.University of California-San Francisco 4.61.University of California-San Francisco 4.62.2.University of Texas-Austin University of Texas-Austin 4.4 4.43.3.University of North Carolina-Chapel Hill 4.2University of North Carolina-Chapel Hill 4.24.4.Purdue UniversityPurdue University 4.1 4.1 University of Arizona University of Arizona 4.1 4.1 University of Michigan Ann Arbor University of Michigan Ann Arbor 4.1 4.1 University of Minnesota Twin Cities University of Minnesota Twin Cities 4.1 4.18.8.University of KentuckyUniversity of Kentucky 4.0 4.0 University of Illinois Chicago University of Illinois Chicago 4.0 4.0 University of Maryland Baltimore University of Maryland Baltimore 4.0 4.02024/4/22 2024/4/22 周一周一1919北京大学第三医院药剂科北京大学第三医院药剂科临床床药学学实践内容践内容n n医院医院医院医院药药学学学学实实践践践践 Hospital Pharmacy Hospital Pharmacy PracticePracticen n特殊患者特殊患者特殊患者特殊患者药药学服学服学服学服务务 Specialty Population Specialty Population Practice Practice n n药师门诊实药师门诊实践践践践 Ambulatory Care PracticeAmbulatory Care Practicen n社区社区社区社区药药学学学学实实践践践践 Community Pharmacy PracticeCommunity Pharmacy Practicen n零售零售零售零售药药店店店店 Retail Pharmacy PracticeRetail Pharmacy Practicen n养老院养老院养老院养老院药药学学学学实实践践践践 Long term