美国医院药师2015工作目标.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,1,美国医院药学工作目标与培训战略,2,美国医院药学工作目标,ASHP,颁布（,2003,年），持续修改。,目的：确保患者用药安全有效。,作法：药师直接为患者提供药学服务，并作为药学工作质量的评价标准。,具体要求：,六个目标，,31,个基本点。,3,六个目标,药师应更多的参与住院患者的个体化给药治疗过程，使住院病人达到最佳的药物治疗效果。,药师更多的参与非住院患者个体化给药治疗过程，使非住院患者达到最佳的药物治疗效果。,药师应主动的提供循证医学证据，以完善药物治疗方案,。,在医疗机构中，药剂科应在促进安全用药方面发挥更显著的作用，和更重要的角色。,医疗机构应增强安全用药方面的技术保障。,拓展医疗机构的药师群体从事社区卫生服务领域的工作内容。,31,个基本点（基本要求,/,具体要求）,4,Goal 1,increase the extent to which pharmacists help individual hospital inpatients achieve the best use of medications.,目标,1,（,6,点）,药师应更广泛的参与住院患者的个体化给药治疗过程，使住院患者达到最佳的药物治疗效果。,5,75%,的医院，药师应收集大部分使用,复杂、高危药物,治疗,的、住院患者的药物治疗史（,收集获得药物治疗史）,。,100%,的医院，药师对使用,复杂、高危药物,的住院患者进行,药物治疗监护（,药学监护）,。,在,90%,的医院，药师与卫生保健团队其它成员合作，参与使用,复杂、高危药物,治疗的住病患者给药方案的制定（,参与给药方案制定）,。,在,75%,的医院，药师对使用,复杂、高危药物,治疗的患者进行出院用药指导（,用药指导）,。,50%,的住院患者（或他们的照顾者）将与药剂师谈话和被随访（,谈话与随访）,。,90%,的医院，在转移交叉的连续治疗期间，药师应作患者的用药依丛性教育工作（,用药依丛性）,。,6,Goal1:Increase the extent to which pharmacists help individual,hospitalinpatients,achieve the best use of medications.,1.1Pharmacists will be involved in managing the acquisition,upon admission,of medication histories for,amajority,of hospital inpatients with complex and high-risk medication regimens*in 75%of hospitals.,1.2The medication therapy of a majority of hospital inpatients with complex and high-risk medication regimens,will be,monitored,*,by a pharmacist,in 100%of hospitals.,1.3,In 90%of hospitals,pharmacists will manage medication therapy,for inpatients with complex and high-risk medication regimens*,in collaboration with other members of the health-care team.,1.4Hospital inpatients discharged with complex and high-risk medication regimens*will receive,dischargemedication,counseling managed by a pharmacist in 75%of hospitals.,1.550%of recently hospitalized patients(or their caregivers*)will recall speaking with a pharmacist while in the hospital.,1.6In 90%of hospitals,pharmacists will ensure that effective medication reconciliation*occurs during transitions across the continuum of care.,7,Complex or high-risk drug regimens,are those that are particularly subject to potential danger or,hazard:e.g,.challenging dosing schedules or routes of administration,medications with documented and significant drug interactions,polypharmacy,and medications with a narrow therapeutic index,insulin,antithrombotics,chemotherapy,etc.,注：,复杂、高危药物治疗：,是指那些有潜在危害的、有明确药物相互作用的、复方制剂、治疗窗窄的、具有特殊给药途经的药物（如胰岛素、抗凝剂、化疗药、地高辛、万古霉素等）。,8,药物治疗监护,：包括的内容很宽泛，以执业药师职责范围内的专业活动和其它经过认证的健康护理者职责为核心内容。主要包括下列项目，但不限于此。,a.,患者健康状况评价,b.,参与药物治疗计划,c.,选择、修改、执行药物治疗方案,d.,监测、评价患者用药效果，包括安全性和有效性。,e.,对药物治疗进行综合观察，分析解决和预防药品不良反应和不良事件。,f.,把护理相关的信息提供给患者的护理人员。,g.,对患者进行口头用药指导和有计划的培训，以增强患者对药物的了解和正确使用的知识。,h.,向患者提供信息和支持服务，以增加患者对疾病治疗方案的理解。,i.,综合的、全方位的对患者进行药物治疗管理。,9,Medication Therapy Management,encompasses a broad range of professional activities and responsibilities within the licensed pharmacists,or other qualified health care providers,scope of practice.These services include but are not limited to the following,according to the individual needs of the patient:,a.Performing or obtaining necessary assessments of the patients health status;,b.Formulating a medication treatment plan;,c.Selecting,initiating,modifying,or administering medication therapy;,d.Monitoring and evaluating the patients response to therapy,including safety and effectiveness;,e.Performing a comprehensive medication review to identify,resolve,and prevent medication-related problems,including adverse drug events;,f.Documenting the care delivered and communicating essential information to the patients other primary care providers;,g.Providing verbal education and training designed to enhance patient understanding and appropriate use of his/her medications;,h.Providing information,support services and resources designed to enhance patient adherence with his/her therapeutic regimens;,i.Coordinating and integrating medication therapy management services within the broader health care-management services being provided to the patient.,10,Goal 2,Increase the extent to which health-system pharmacists help individual non-hospitalized patients achieve the best use of medications.,目标,2,（,4,点）,药师应更广泛的参与非住院患者个体化给药治疗过程，使非住院患者达到最佳的药物治疗效果。,11,70%,的医疗诊所，药师与卫生保健团队其它成员合作，参与使用复杂、高危药物患者的药物治疗方案的制定（,参与给药方案制定）,。,95%,的医疗诊所，药师应常规的对使用复杂、高危药物患者进行用药指导（,用药指导）,。,对,90%,的家庭护理服务患者，药师与卫生保健团队其它成员合作，参与使用复杂、高危药物的患者的药物治疗方案制定（,参与给药方案制定（家庭护理服务）,。,对,90%,需要长期使用护理设施的患者，药师与卫生保健团队其它成员合作，参与使用复杂、高危药物患者的药物治疗方案制定（,参与给药方案制定（长期使用护理设施）,。,12,Goal 2,Increase the extent to which health-system pharmacists help individual,non-hospitalized patients achieve the best use of medications.,Objective2.1,In 70%of health systems providing clinic care,pharmacists will manage medication therapy,for clinic patients with complex and high-risk medication regimens*,in collaboration with other members of the health-care team.,Objective2.2,In 95%of health systems providing clinic care,pharmacists routinely counsel clinic patients,with complex and high-risk medication regimens.,Objective2.3,In 90%of home care services,pharmacists will manage medication therapy,for patients with complex and high-risk medication regimens*,in collaboration with other members of the health-care team.,Objective2.4,In 90%of long term care facilities,pharmacists,will manage medication therapy,for patients with complex and high-risk medication regimens*,in collaboration with other members of the health-care team.,13,Goal 3,Increase the extent to which health-system pharmacists actively apply evidence-based methods to the improvement of medication therapy.,目标,3,（,4,点）,药师应主动的提供循证医学证据，以完善药物治疗方案,。,14,90%,医院，药师应对那些需要个体化给药方案治疗的患者提供基于药品质量信息、临床研究信息、治疗指南及专家意见为依据的循证医学信息支持（,提供循证医学信息）,。,90%,医院，药师应参与基于循证医学基础的药物治疗方案协定处方的改进与完善（,协定处方制定）,。,90%,的医院，药剂科应参与确保患者接受基于循证医学的,药物治疗方案,的工作中。此方案是经过,CMS,等机构认同的（,确保循证治疗）,。,70%,的医院，药师应参与,控制感染,相关的预防用药和预防接种疫苗工作（,参与院感和预防接种工作）,。,注：,CMS,：美国医疗保险和医疗补助中心,15,注：,药物治疗方案：,目前包括,21,个临床治疗方案，其中,13,项包括药物。,如急性心肌梗塞（,ASA,、,B,受体阻滞剂、,ACEI,、纤溶剂）,心衰（,ACEI,、,ARBS,）,外科手术的预防等。,注：感染控制,：以降低住院患者感染发生率为目的工作规程，包括对所使用的药物或疫苗进行管理。如抗菌药物的管理、疫苗的使用率、外科预防使用抗生素的管理。,16,Goal 3,Increase the extent to which health-system pharmacists actively apply evidence-based methods to the improvement of medication therapy.,Objective 3.1,In 90%of hospitals,pharmacists will be actively involved in providing care to individual patients that is based on evidence,such as the use of quality drug information resources,published clinical studies or guidelines,and expert consensus advice.,Objective 3.2,In 90%of hospitals,pharmacists will be actively involved in the development and implementation of evidence-based drug therapy protocols and/or order sets.,Objective 3.3,In 90%of hospitals,pharmacy departments will actively participate in hospital-wide efforts to ensure that patients receive evidence-based medication therapies required by the CMS hospital quality initiative,Joint Commission Core Measures,and/or state-based quality improvement and public reporting efforts.,Objective 3.4,In 70%of hospitals,pharmacists will actively be involved in medication-and vaccination-related infection control programs.,17,Goal 4,Increase the extent to which pharmacy departments in health systems have a significant role in improving the safety of medication use.,目标,4,（,7,点）,在医疗机构中，药剂科应在促进安全用药方面发挥更显著的作用，是更重的角色。,18,90%,的医疗机构，应制定工作计划，每年一次评价用药安全性,以改进工作为目的（,设立机构）,。,80%,的医疗机构药剂科应对无菌药品配制工作进行年度评价，应符合相应标准和规范的要求（,无菌配制评价）,。,80%,的医院，至少,95%,的医嘱在患者第一次用药前，应当经过药剂师对其适宜性进行审核（不包括急诊、外科手术、分免阵痛、心导管插入术等）（,用药审核）,。,90%,的医院药师应参与确保外科患者接受抗菌药物预防感染时，在手术后,24,小时以内停药（,手术预防用药临管）,。,85%,的医疗机构药学技术员经过药学技术认证委员会认证（,老技术员认证要求）,。,19,6,、,50%,新进入医疗机构的药学技术员应完成,ASHP,认可的药学技术训练项目（,新技术人员认证要求）,。,7,、,90%,新进入医疗机构工作的药师，应完成,ASHP,认证的住院药师培训项目（,新药师资质要求）,。,20,Goal4,Increase the extent to which pharmacy departments in health systems have a significant role in improving the safety of medication use.,Objective4.1,90%of health systems will have an organizational program,with appropriate pharmacy involvement,to achieve significant annual,documented improvement in the safety of all steps in medication use.,Objective4.2,80%of pharmacies in health systems will conduct an annual assessment of the processes used throughout the health system for compounding sterile medications,consistent with established standards and best practices.,Objective4.3,80%of hospitals have at least 95%of routine medication orders reviewed for appropriateness by a pharmacist before administration of the first dose.,(*Not including doses required in the context of emergencies or immediate procedures such as surgeries,labor and delivery,cardiac catheterization,etc.,Objective4.4,90%of hospital pharmacies will participate in ensuring that patients receiving antibiotics as prophylaxis for surgical infections will have their prophylactic antibiotic therapy discontinued within 24 hours after the surgery end time.,Objective4.5,85%of pharmacy technicians in health systems will be certified by the Pharmacy Technician Certification Board.,Objective4.6,50%of new pharmacy technicians entering hospital and health system practice will have completed an ASHP-accredited pharmacy technician training program*.,Objective4.7,90%of new pharmacists entering hospital and health-system practice will have completed an,ASHPaccredited,residency.,21,Goal 5,Increase the extent to which health systems apply technology effectively to improve the safety of medication use.,目标,5,（,5,点）,医院应在改进用药安全性方面提供技术保障。,22,75%,的医院应使用机器可识别的编码，以便在调配药品之前核对药品（,防止调配错误）,。,75%,的医院应使用机器可识别的编码，以便在给患者用药之前核对药品信息和患者信息（,防止发药错误）,。,70%,的医院应使用电子处方为住院患者下医嘱，包括临床决策的支持系统（,电子处方）,。,65%,的医疗机构，药师应使用与患者治疗有关的电子病历，以便监护患者的药物治疗过程（,电子病历）,。,70%的医疗机构，药师应能够提取和交流患者的信息，以保证那些使用复杂、高危药品的患者能够得到持续的药学监护（,电子信息利用）,。,23,Goal5,Increase the extent to which health systems apply technology effectively to improve the safety of medication use.,Objective5.1,75%of hospitals will use machine-readable coding to verify medications before dispensing.,Objective5.2,75%of hospitals will use machine-readable coding to verify all medications before administration to a patient.,Objective5.3,For routine medication prescribing for inpatients,70%of hospitals will use computerized,prescriber,order entry systems that include clinical decision support.,Objective5.4,In 65%of health systems,pharmacists will use medication-relevant portions of patients electronic medical records for managing patients medication therapy.*,Objective5.5,In 70%of health systems,pharmacists will be able to access pertinent patient information and communicate across settings of care to ensure continuity of pharmaceutical care for patients with complex and high-risk medication regimens,.,24,Goal 6,Increase the extent to which pharmacy departments in health systems engage in public health initiatives on behalf of their communities.,目标,6,（,5,点）,拓展医疗机构的药师群体从事社区卫生服务领域的工作内容。,25,60%,的医疗机构药师应定向的开展社区卫生保健服务（,社区卫生保健）,。,50%,的医疗机构药房应直接参预社区的免疫接种工作（,社区免疫接种）,。,85%,医疗机构药师应参加保证适应症患者接受流感疫苗和肺炎链球菌疫苗的接种工作（,社区免疫接种）,。,80%,的医院药师应对住院患者进行停止吸烟的辅导教育（,禁烟教育）,。,90%,的医疗机构药房应备有急救药物，与其医疗机构和所在社区规模相配套（,急救设施）,。,26,Goal 6,Increase the extent to which pharmacy departments in health systems engage in public health initiatives on behalf of their communities.,Objective 6.1,60%of pharmacies in health systems will have specific ongoing initiatives that target community health.,Objective 6.2,50%of pharmacy departments in health systems will be directly involved in ongoing immunization initiatives in their communities.,Objective 6.3,85%of hospital pharmacies will participate in ensuring that eligible patients in health systems receive vaccinations for influenza and,pneumococcus,.,Objective 6.4,80%of hospital pharmacies will participate in ensuring that hospitalized patients who smoke receive smoking-cessation counseling.,Objective 6.5,90%of pharmacy departments in health systems will have formal,up-to-date emergency preparedness programs integrated with their health systems and their communities preparedness and response programs.,27,小结：到,2015,年,ASHP,医院药师行动计划,药学服务的评价标准,六个目标,31,个基本点,赋予了药师这个职业更多新的任务，药师必须承担起管理患者药物治疗的责任。,实施过程是药师角色的转变过程。,挑战与机遇。,药师必须寻求和争取社会对药师管理患者药物治疗这个角色的接受。,28,美国药师培训战略,ACCP,观点综述,战略,/,规划,/,计划,/,制度,29,美国药房的人员结构,药剂师,（工作人员，行政人员，临床药师）,药房技术员（认证，非认证）,药房助手,行政助理,库存管理人员,30,美国临床药理学会,(ACCP),核心内容,到,2020,年药学院毕业生在正式工作前必须参加住院培训，这是需要强制执行的。,目的：让药师具有直接为患者提供服务的能力。,背景,住院药师培训是以病人为中心的药学服务模式的需要,。,当代医生的能力无法控制复杂的药物治疗。,临床对药物治疗的管理和对循证药物治疗学的需求。药师在临床发挥的作用越来越大。,如果住院药师培训不作为一项强制性的培训，毕业生们很有可能会倾向选择那些不要求这项培训的医疗单位就业。,这些都在迫使药学教育的不断改革。,31,住院药师培训战策的基本框架,一、,从事临床工作的药师必须承担起管理病人药物治疗的责任，同时这也是他们的义务。,药物疗效的观察与评价,药物选择,药物剂量调整,监测个体化给药方案,药师与多人组成的医,疗团队的合作,32,The best pharmaceutical treatment options are presented to physicians.,提供最好的治疗方案给医生。,Physician-prescribed treatments are administered properly,。,执行医生的医嘱。,Patients understand their medications,and how to take them,。,使患者了解他们所用药物和如何使用。,Preventable interactions and adverse effects are avoided.,避免药物相互作用和不良反应。,Currently,43 states have approved regulations that authorize and support formal practice agreements between pharmacists and physicians to facilitate the collaborative management of patients drug therapy.,43,个项目被批准与医生共同承担药物的治疗。,33,二、“所有药师都能为病人提供药学监护”，到,2020,年所有医疗机构都要达到这项标准。,三、药师将作为患者的健康专家，无论是在社区还是在医疗机构都将直接为患者提供专业的服务。,34,四、为病人,直接提供药学服务,，将会成为今后,药学服务的标准,。,将会改变以往住院药师培训“可有可无”的状况。,所有希望从事临床工作的药学院毕业生今后都会寻求住院培训的机会。,35,五、住院药师培训项目的主要推动力，是将其与今后的就业和收入挂钩。,例（医生）：医疗单位还是更加信任那些不仅仅有资格证的医生，他们更加信任那些参加过住院医师培训的医生，,保险公司,也更加愿意付费给这类医生。,36,例（药师）：国立大药房的药师，不必参加住院药师培训。,但是顾客和药店老板还是更加青睐那些接受过住院药师培训的药师，这也是开展药师培训制度的一个有效推动力。,老板会更加信任那些接受过培训的药师，在薪水上也会给予他们更多的优待。,37,六、培训经费,住院药师培训基地将继续由美国医疗保险和医疗补助中心（,CMS,）提供培训经费，接受培训的药师也将继续获得（,CMS,）的资助。,38,七、住院药师培训需要发展出一套多年连贯的培训体系。,第一年,(postgraduate year 1 PGY1),培训：,第一年的培训重点是基础药学技能，通科住院药师培训。,第二年,(postgraduate year 2 PGY2),培训：,是高级技能的训练阶段，应当使药师能够成为专科住院药师，具有为专科病人和特殊群体患者提供,药学监护,的能力。,必须完成,PGY1,的培训，才能进入,PGY2,阶段。,39,八、师资：,目前从业的药师需要归纳总结药学服务的经验。他们的经验可以指导住院药师的培训，,(,例如，他们可以加入到住院药师的培训中，作为他们的指导老师,),，但是，前人的经验指导只是住院药师培训的一小部分内容，采取不同的培训手段来提高住院药师的临床技能。,40,住院药师培训具体作法,41,一、建立和认证培训基地,基地数量,在,2005,年，住院药师培训基地的总数达到,770,个（,482,个药学实践基地和,288,个专科住院培训基地）。,培训基地的总数特别是药学实践基地的数量一直都在增长。,基地与培训岗位设置,基地认证后，岗位自行设置。,毕业生人数,现在,8000,人,/,年,2020,年,10000,人,/,年,42,2020,年对药师需求量,药学技术员,：,10,万人。不直接参与病人的监护，但是他们负责药物的分发过程，包括监督药技师和自动发药机的发药。这些药学技术员将保证药品发放的准确性安全性。这些人员不但需要药学知识同时还要有机械工程的知识背景。,社区药师,：主要在社区药房和流动医疗站工作药师，需要,165000,名。他们向患者提供基础医疗服务。,43,医院药师,：需要,13,万药师为二级和三级医院服务。这些药师将在医院和更高级的流动医疗站工作（例如三级医疗单位的临床工作）。,不直接为患者服务的药师,：,22000,名药师将参与不直接服务于患者的药学工作（例如管理制药企业，或其他岗位）,3250,名教师,药师总需求：,2020,年上述各个岗位的药师总数估计将达到,420250,名44,假设到,2020,年，将会有,7500,名药师参,PGY1,培训，而目前只有,1250,个这样的岗位，以此计算每年需要新增,415,个岗位到,2020,年才能满足条件（以后,15,年或,15,年以后），这看来将是一种直线增长的态势。,例如，联邦政府对住院药师培训投入的增加，或者允许对住院药师的服务付费，这些都将使住院培训的岗位数量迅速增长。,45,二、发放资格证书,“,所有直接为病人提供服务的药师都需要有一份可靠的,证明,来证实他的药学服务水平。住院药师培训将成为每一个初级药师必须参加的培训。”,基地发放资格证书,46,三、分阶段培训,住院药师的培训任务将被分为,初级阶段,毕业第一年PGY1,）,高级阶段,毕业第二年（,PGY2,）。,47,PGY1,（毕业后第一年住院培训）,第一年,(postgraduate year 1 PGY1),培训：,第一年的培训重点是基础药学技能，通科住院药师培训,。,PGY1,的目标是要拓展住院药师的综合素质。,药学研究人员必须参加的,PGY1,培训，,为保证药学研究人员的基本临床能力和经验，特别是那些参加临床研究工作的人员。,48,例,:,“,社区药学服务,”,项目培训,获得更多的商业管理的经验,把工作重点放在社区保健和疾病预防工作,将社区药房作为主要培训基地,49,PGY2,（毕业后第二年住院培训）,第二年,(postgraduat