With rich knowledge of modern pharmacy, clinical pharmacists cooperate with doctors to provide and design the safest and most reasonable medication scheme for patients. Clinical pharmacists play a key role in helping doctors use drugs rationally. They can help doctors prescribe the right drugs and the right dosage for patients at the right time, avoid the adverse interaction between drugs, solve the problems related to drug treatment, and play an important role in clinical rational drug use. For doctors who are difficult to master and use the comprehensive knowledge of modern drugs for rational drug use, the emergence of clinical pharmacists undoubtedly provides a strong guarantee for them to make full use of drugs and ensure the rationality, safety and effectiveness of drug treatment, which is naturally welcomed by clinicians. In some large medical centers in the United States, clinical pharmaceutical service institutions are generally set up, and one or several doctors must cooperate with a clinical pharmacist. It is impossible for medical institutions to participate without clinical pharmacists.

background

Clinical pharmacy originated in America. At that time, adverse drug reactions and drug-induced damage brought pain and heavy burden to many patients, families and society. The needs of society and patients contributed to the birth and development of clinical pharmacy. In 1950s and 1960s, the United States first established a new discipline-clinical pharmacy, which shifted the focus of traditional pharmacy education from "medicine" to "people". Hospital pharmacists not only complete the supply and distribution of drugs, but also participate in doctors' medication and assist in clinical drug selection to improve the curative effect and reduce the occurrence of side effects. Due to the successful practice of American pharmacy, many countries have followed suit, and it is an inevitable trend for hospital pharmacy to develop patient-centered pharmaceutical services and improve the overall pharmaceutical level of hospitals.

Therefore, two changes have taken place in the field of international pharmacy. On the one hand, doctors who focus on diagnosis need the help of pharmacists in the selection and use of therapeutic drugs; On the other hand, patients' enhanced awareness of self-protection makes them need to know more about what they are using, which leads pharmacists to shift their focus to clinical pharmacy. The development of clinical pharmacy in developed countries for more than 40 years shows that clinical pharmacists' participation in treatment plays an important role in promoting rational drug use and reducing adverse reactions and waste of health resources.

Development situation

Western developed countries generally began to offer clinical pharmacy specialty in 1960s. In 2002, China issued a document stipulating the gradual establishment of a clinical pharmacist system. Taking pharmaceutical education in the United States as an example, 1957 implemented the professional education course of Pharm.D, and 1967 proposed that students majoring in clinical pharmacy should carry out clinical practice. 1974 stipulates that they must be in clinical practice 1500 hours, which was decided by the American Pharmaceutical Education Committee on1July l4, 997. After nearly 50 years of development, American pharmacy has fully developed the professional education of pharmacy doctor.

In China, in the 1960s, under the planned economy system, China's drug market system was still not perfect, with a single variety of medical drugs, backward preparation production equipment and a shortage of pharmaceutical professionals. The main task of hospital pharmacy is to ensure the supply of drugs and meet the clinical drug demand. Therefore, although domestic scholars proposed to carry out clinical pharmacy more than 40 years ago, the subjective and objective conditions at that time did not have or allowed to carry out clinical pharmacy work. Until the early 1980s, with the opening and prosperity of the domestic pharmaceutical market, the gradual standardization of drug management, and the establishment of new disciplines such as pharmacokinetics and biopharmaceutics, rational drug use in hospitals finally got the attention of the medical community, and clinical pharmacy really started and developed.

In the past 20 years, some achievements have been made in the development of clinical pharmacy in China:

policy support

1987, the Ministry of Health approved 12 key hospitals as national clinical pharmacy pilot units; 199 1 year, the Ministry of Health stipulated for the first time in the hospital classification management document that tertiary hospitals must carry out clinical pharmacy work and take it as one of the hospital assessment indicators; June 5438+October 2002 10, the Ministry of Health and state administration of traditional chinese medicine promulgated the Interim Provisions on Pharmaceutical Affairs Management in Medical Institutions, which made it clear that "clinical pharmacy should be patient-centered, combined with medicine in clinical diagnosis and treatment activities, and clinical pharmacy professionals should participate in the design of clinical drug treatment schemes, establish the medication history of key patients, implement therapeutic drug monitoring, and gradually establish a clinical pharmacist system ...", In June, 2005 165438+ 10, the Notice on the Pilot Work of Clinical Pharmacist Training was issued, and the Pilot Work Plan of Clinical Pharmacist Training and its four annexes were published. In 2006, "On-the-job Training and Assessment Standards for Clinical Pharmacists (Trial)" was issued, and 19 Hospital was designated as the national training base for clinical pharmacists, and the training mode was put forward. This work has accumulated some experience since it started in 2007. In 2007, document No.2007 19991February 15 clearly pointed out that 42 hospitals were taken as the pilot to carry out the pilot work of the pharmacist system. In principle, the number of clinical pharmacists is not less than 5 in tertiary hospitals and not less than 3 in secondary hospitals.

Education and training

Since the early 1980s, China has carried out various forms of clinical pharmacist education. In terms of academic education, the former School of Pharmacy of West China University of Medical Sciences and Dalian Medical College set up five-year undergraduate clinical pharmacy majors respectively. Although some work has not been continued, it provides exploratory experience for the curriculum setting of clinical pharmacy specialty and the training of clinical pharmacists in the future. 1999 The Ministry of Health promulgated the Standardized Training Program for Hospital Pharmacists (Trial), which stipulated that clinical knowledge training should be carried out at the end of the two-stage training 1 year, and clinical departments should participate in internships, including rounds, consultations and medication. The curriculum system reform project "Research on the Curriculum System and Content of Clinical Pharmacy" oriented to the teaching content of 2 1 century by the Ministry of Education has been completed and a clinical pharmacy curriculum group has been established, and the textbook "Various Theories of Clinical Pharmacy" has also been published. In addition, a number of plans to reform pharmaceutical education and train clinical pharmacists are also in full swing. Shanghai Fudan University School of Pharmacy, Second Military Medical University and West China Medical Center of Sichuan University are all preparing to offer postgraduate courses in clinical pharmacy. In the aspect of continuing education, all kinds of clinical pharmacist training classes and new progress classes in clinical pharmacy have sprung up like mushrooms after rain, and gradually standardized and institutionalized, which have taught a large number of pharmaceutical technicians new knowledge and skills in clinical pharmacy and played a positive role in the clinical pharmacy work of on-the-job pharmacists in hospitals. Therefore, China has initially established a dual-track parallel education and training model, especially the academic education of clinical pharmacists is in a turning point or breakthrough stage.

Service belief

The concept of rational drug use has been widely recognized inside and outside the pharmaceutical field, and both pharmaceutical journals and public media have shown unprecedented enthusiasm for rational drug use. Taking the full-text database of China journals as an example, the annual growth rate of literature retrieval with the theme of "rational drug use" or "clinical pharmacy" is about 20%; Some academic journals of clinical pharmacy have also been published, such as China Journal of Clinical Pharmacy, which was founded by 1992, and Pharmaceutical Service and Research, which was sponsored by Changhai Hospital of the Second Military Medical University in 2000/kloc-0. It is a professional journal with the purpose of popularizing clinical pharmacy and promoting pharmaceutical service. In 2004, "China Journal of Clinical Pharmacy" and "Pharmaceutical Service and Research" became the core journals of science and technology in China at the same time, which also reflected the improvement of the quantity and quality of related literature. From the literature published in recent years, domestic clinical pharmacists have gradually participated in clinical drug treatment, such as providing pharmaceutical information services, monitoring therapeutic drugs, and monitoring the adverse drug reactions of Yamatonokusushi. Especially in the clinical practice of pharmacists, domestic clinical pharmacists have summarized and practiced a variety of clinical participation modes, such as expert mode (participating in clinical rounds, consulting and interpreting the monitoring results of therapeutic drugs), generalist mode (satellite pharmaceutical work and information consultation) and various audit and inspection modes (drug inspection in wards, audit of intravenous drug allocation centers and collection of adverse drug reactions).

Working system of clinical pharmacists

In order to implement the spirit of the Interim Provisions of the Ministry of Health on the Administration of Pharmaceutical Affairs in Medical Institutions, and according to the Detailed Rules for the Implementation of Hospital Grade Evaluation of Hubei Provincial Health Department and the relevant provisions and requirements of the annual activities of hospital quality management, this method is formulated to explore the establishment of a working mode suitable for hospitals, improve medical quality and standardize the working mode of clinical pharmacists.

Responsibilities of clinical pharmacists:

(1) Participate in the design and implementation of clinical drug treatment schemes, and assist clinicians in drug selection and rational drug use, so as to prevent or reduce drug-related damages, improve the level of clinical drug treatment and improve the quality of life of patients.

(2) to carry out pharmaceutical information and consulting services, carry out medication education, publicize and guide patients to use drugs safely.

(3) Carry out clinical pharmaceutical research to provide scientific monitoring or experimental data for improving the level of drug treatment.

(4) Undertake clinical pharmacy education in hospitals, train pharmacists, doctors and community doctors, and carry out medication education for patients.

Work contents of clinical pharmacists:

(1) Go deep into clinical departments to understand the trends of drug application and put forward suggestions for improvement;

(2) Attend rounds and consultations, participate in the treatment of critically ill patients and discuss medical records, and make suggestions on drug treatment;

(3) Monitoring therapeutic drugs and designing individualized administration plan;

(4) Instruct nurses to get, keep and use drugs correctly;

(5) Assist clinicians in clinical observation of new drugs after they are marketed, and collect, sort out, analyze and feed back drug safety information;

(six) to provide drug consulting services and publicize the knowledge of rational drug use;

(7) Carry out drug evaluation and drug utilization research in combination with clinical medication.

Working procedures for clinical pharmacists to go deep into clinic;

(1) Go to the ward to check the patient first, or learn the general situation of the patient and the latest inspection data through the computer.

(2) to participate in medical rounds, and put forward suggestions on medication in the rounds; Instruct patients to take drugs, inquire and observe the situation after taking drugs, understand the interaction between drugs and food, ensure the safe use of drugs, and record them in the medication calendar written by pharmacists; If an adverse drug reaction is found, enter the adverse reaction handling procedure; Put forward opinions on whether the patient needs to monitor the blood drug concentration after taking the medicine, analyze the monitoring results of the blood drug concentration, and formulate and adjust the administration plan according to the parameters;

(3) guiding the medication of special patients;

(4) Participate in the rescue of critically ill patients and give on-site medication guidance;

(5) Providing drug consultation for doctors, nurses and patients.

The system and index of clinical pharmacists' participation in clinical work;

(1) According to the responsibilities of clinical pharmacists, clinical pharmacists should regularly go to clinical wards to participate in clinical drug treatment rounds, consultations, first aid and case discussions.

(2) Clinical pharmacists should make in-depth clinical rounds not less than 10 times per month, with each time being not less than 2 hours;

(3) Clinical pharmacists' rounds are divided into follow-up rounds and clinical pharmacists' rounds alone. Follow the clinician's rounds, focus on the patient's condition and treatment difficulties, and participate in the medical group discussion at the end of rounds. Clinical pharmacists' separate rounds are mainly aimed at key patients under special circumstances (such as adverse drug reactions, critically ill patients, patients with complicated drug treatment and severe damage to liver and kidney functions, etc.). ). Clinical pharmacists can ask patients or accompanying personnel after consulting medical records and communicating with doctors to understand the condition. Make at least/kloc-0 rounds in a single pharmacy every week, establish a medication calendar for key patients, and make work records;

(4) Participate in the rescue of critically ill patients and discuss medical records, and make records. Before attending the consultation, clinical pharmacists should consult medical records, ask questions in advance, understand the condition, consult and calculate the necessary data, and put forward scientific and cautious opinions to help clinicians improve the treatment effect. Clinical pharmacists should actively participate in and participate in other related consultations in their clinical departments;

(5) Make work summary every week, hold 1 work meeting every month, exchange experiences, communicate information and discuss difficult medical calendars;

(6) Clinical pharmacists should actively consult pharmaceutical information and give positive answers to questions raised by doctors, nurses and patients. If you can't give an answer at that time, you should record it in time, consult relevant experts or consult relevant materials afterwards, and try your best to give a satisfactory answer. Key consultation or typical problems should be recorded in detail and summarized at the end of the year;

(7) Collect, sort out, analyze and feed back drug safety information, do a good job in monitoring adverse drug reactions, actively care for and guide patients with adverse reactions, and help them improve drug compliance. Do not miss serious adverse drug reactions, and publish 1 drug news every quarter;

(8) Assist medical staff in designing, applying, sampling, interpreting and adjusting medication according to clinical needs and drug characteristics, actively record patients' condition and monitoring results, and accumulate population pharmacokinetic data.

(9) In combination with clinical medication, actively carry out drug evaluation and drug utilization research such as medical records and prescription analysis, establish 1 key drug utilization research topics every year, and write research and analysis reports; Actively communicate with medical staff in many aspects, find out the urgent clinical pharmaceutical research topics, and promote the development of clinical pharmaceutical research; Hold pharmaceutical education lectures at least once a year, with lecture notes and published papers 1 more;