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ZHU Yu-lin; ZHANG Yong; LIU Yan1; XING Rong

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- China Pharmacy Vol. 26, Issue 35, (2015)
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ZHU Yu-lin, ZHANG Yong, LIU Yan1, et al. [J]. China Pharmacy 26(35).(2015)
DOI：

ZHU Yu-lin, ZHANG Yong, LIU Yan1, et al. [J]. China Pharmacy 26(35).(2015) DOI：

摘要

目的：探讨药物重整在临床药师开展药学监护工作中的作用。方法：临床药师参与1 例高龄患者治疗的药学监护，就患者的抗感染药物、心血管系统药物、电解质等治疗药物进行重整：停用非必需药物血必净注射液、康尔心胶囊、蛇胆川贝软胶囊、枸橼酸莫沙必利片；调整氢氯噻嗪片、氯化钾缓释片剂量；停用非一线治疗药物利血平片，降低潜在的用药风险；根据病情转归及时停用呋塞米片、乳果糖口服溶液和开塞露。结果与结论：临床药师通过药物重整，可避免重复用药，优化用药方案，减少用药品种和药品费用，降低潜在的药品不良反应风险，保障患者用药安全、有效。

Abstract

OBJECTIVE：To investigate the role of medication reconciliation in pharmaceutical care provided by clinical pharmacists. METHODS：Clinical pharmacists participated in pharmaceutical care for a elderly patient，and reconciled drugs as anti-infective drugs，cardiovascular drugs，electrolyte：stop taking unnecessary drugs：Xuebijing injection，Kang’erxin capsule，Shedan chuanbei soft capsule，Mosapride citrate tablet；adjust the dose of Dihydrochlorothiazide tabet and Potassium chloride tablet；stop taking Non first-line drug Reserpine tablet in order to decrease the risk of drug use； stop taking Furosemide tablet，Lactulose oral solution and using Suppositories glycerol timely according to the disease outcome. RESULTS&CONCLUSIONS：The medication reconciliation can avoid repeated drug use，optimize medication plan，reduce drug variety and cost and decrease the potential ADR risk of drug use so as to guarantee safe and effective drug use.

关键词

药物重整临床药师药学监护用药差错

Keywords

medication reconciliationClinical pharmacistPharmaceutical careMedication errors

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Dept. of Pharmacy， Second Affiliated Hospital， Army Medical University

Dept. of Pharmacy， Chongqing Health Center for Women and Children/Women and Children’s Hospital of Chongqing Medical University

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