药师在肠内肠外营养支持中的作用及干预实例

Role of Pharmacists in Rational Use of Parenteral and Enteral Nutrition and Case Introductions

关键词:  临床药师  药剂作业  肠外营养  肠内营养  药学监护

Key words:  clinical pharmacist  dispensing pharmacist  clinical nutrition  parental nutrition  enteral nutrition  pharmaceutical care

摘要:

目的 促进药师在临床营养支持中积极发挥作用，提高药师专业形象和药学服务效率。方法 介绍了浙江大学医学院附属第二医院药师在肠内肠外营养支持中的工作模式以及成效。结果 临床药师通过参与临床查房和医嘱开立、咨询、讲座宣教、药品不良反应会诊处理等，提供全程药学监护。病区药剂作业的药师通过严格的收费前医嘱审核、与临床医生积极沟通、肠外营养液的集中配置、处方点评和流程管理，保证肠外肠内营养的合理性和使用安全性。不同岗位药师开展了相应的药学服务，互相合作取得了较高的临床满意度。结论 肠内肠外营养的合理用药干预需要团队合作，临床药师和药剂作业的一线药师需要紧密合作，从不同的侧重点切入，点面结合，才能将药学服务做精做细。

Abstract:

OBJECTIVE To promote the active role of pharmacists in rational use of parenteral and enteral nutrition and to improve the professional image of pharmacists and efficiency in pharmaceutical care service. METHODS The working mode in our hospital was introduced. RESULTS Clinical pharmacists provide integral pharmaceutical care by ward rounding, suggestions for doctors’ writing medical orders, drug counseling, patient education, lecture and adverse drug reaction consultations. Pharmacists in inpatient pharmacy and center of pharmacy intravenous admixture service (PIVAS) warrant rationality of medical orders and safety in clinical use by prescription auditing, mutual communications between doctors and auditing pharmacists, centralized admixture service, retrospective prescription evaluation and procedure administration. Both kinds of pharmacists conduct corresponding pharmaceutical service and obtained high degree of satisfaction from clinical doctors, nurses and patients. CONCLUSION Collaborations between clinical pharmacists and pharmacists in PIVAS and inpatient pharmacy can enhance the rational use of parental and enteral nutrition.