Pharmacological Care (Pharmacentical Care or PC for short) is a
hot topic in the field of hospital pharmacy at home and abroad in recent years. It is an important part of the implementation of medical prevention and treatment in hospitals, and is also an important aspect of the 21st century pharmacy work model
reform. Modern hospital pharmacy will be transformed from drug supply management to pharmacy guardianship. With the development of society
and the updating of concepts, health needs pharmacy guardianship, and pharmacy guardianship is also the way out for traditional Chinese pharmacists.
In the past, pharmacists seldom had contact with patients, and the pharmacist's task was to dispense and supply drugs. With the development of hospital pharmacy
and especially the rise of clinical pharmacy, this situation is undergoing a fundamental transformation. The development of hospital pharmacy
has gone through three periods ① the traditional period of dispensing as the main focus ② the period of clinical pharmacy as the main focus of pharmacy services
③ the period of pharmacy guardianship with the goal of improving the quality of life of patients. The three main components of pharmacy supervision are: pharmacist participation in the clinic, therapeutic drug monitoring and drug information counseling. Pharmacist participation in the clinic, will enable the pharmacist to establish direct contact with the patient
People, directly involved in the development of drug therapy programs, which is a fundamental shift in the function of the pharmacist, meaning
Meaning that the pharmacist has to assume the responsibility of the patient's treatment of the whole process of medication guardianship.
Pharmacological treatment has relieved pain and brought happiness to many patients, but it has also caused harm to many people,
causing sequelae and even death. In fact, most of the problems are not caused by the drugs themselves, but by the improper process of prescribing, dispensing, or giving
drugs. Therefore, pharmacists have an ethical responsibility to protect their patients from the worry of drug-related problems.
With the change of people's health concepts, the quality of treatment and quality of life requirements continue to improve, no longer satisfied with
Sufficient to have medicines available, but rather require to enjoy high-quality, safe, reasonable and economical services, pharmacy guardianship should be
Born has become an inevitable trend. [1]
1. Definition of PharmacovigilancePharmacovigilance is a process by which a pharmacist, in collaboration with the patient and other professionals,
designs a therapeutic plan, the implementation and monitoring of which will have a particular therapeutic effect on the patient. It consists of
3 functions ① identifying potential or actual medication problems ② resolving actual medication problems ③ preventing
potential medication problems from occurring.
A uniform definition of pharmacovigilance is: "The mission of the pharmacist is to provide pharmacovigilance. Pharmacovigilance is the provision of
direct, responsible medication-related supervision with the goal of improving the quality of patient life" [2]. The pharmacist's work
has to be directly patient-oriented, and he or she has to assume social responsibility for monitoring, enforcing, and protecting the safe and effective use of medications by patients
in order to maximize the improvement of patients' physical and mental health.
2, the main content of the pharmacy guardianship
2, 1, the medical, pharmacy, nursing organically together, so that doctors, pharmacists, nurses work together
power, *** with the medical responsibility.
2, 2, both for the individual patient, and for the whole society national health education services.
2, 3, guidance, to help patients and health care workers safe, effective and rational use of drugs.
2, 4, regular scientific assessment of the use and management of drugs.
It can be seen that the hospital pharmacist's way of working will change, they are not just modulating drugs, but
to work with doctors and nurses to directly face the patient, participate in the treatment, guidance on the use of medication, working in the clinical front line.
3, the pharmacist's duties and tasks in pharmacological supervision
3, 1, with the doctor to decide whether the patient needs to carry out drug therapy, clear therapeutic goals, for this
goal to design a drug therapy program, to monitor the whole process of patient medication, to make a comprehensive evaluation of drug therapy, to find
and report allergic reactions to medications and side effects, to minimize adverse drug reactions and harmful side effects. Minimize the occurrence of adverse drug reactions and harmful drug interactions
.
3. 2. Integrates the management of all resources necessary for pharmacy supervision, including people and medications.
3. 3. 3. Ensure the rational use of medication, i.e., safe, effective, and economical use of medication by selecting safe and effective medications, appropriate
dosage forms, routes of administration, and methods of administration based on the patient's type and nature of disease, time of onset, history of previous use of medications, and the presence or absence of drug allergies.
The pharmacist's specific task in providing pharmacological supervision is to detect, prevent, and resolve medication-related problems. The pharmacist's task is to detect, prevent, and resolve problems related to the use of medications, such as (1)
correct medications; (2) appropriate indications for the use of medications; (3) safe therapeutic efficacy at an appropriate price; (4) appropriate dosage, usage, and regimen (based on the knowledge of pharmacokinetics and pharmacodynamics to determine the dosage and regimen); (5) appropriate target audience for the use of medications (no contraindications,
small adverse reactions); (6) no errors in the mixing and dispensing of medications; and (7) good compliance by the patient. [3]
4, the hospital pharmacist in the pharmacy guardianship status
4, 1, the pharmacist's client is the patient
As the patient's client, the pharmacist must be with the patient to establish a "one-to-one" business relationship.
4, 2, the establishment of "prescriber, pharmacist, patient" new partnership
Pharmacology guardianship requirements to break the division of labor within the pharmacy, such as "pharmacy pharmacist", "preparations pharmacist ". All
all pharmacists are asked to assume responsibility for patient care, and all pharmacy department staff are considered to be providers
of patient care. Other members of the medical staff and patients can have direct conversations with the pharmacist, acting as physician extenders and becoming part of the healing
team. [4]
5. Importance of carrying out pharmacological supervision
Firstly, it promotes the rational use of drugs and improves the therapeutic effect of drugs, secondly, it reduces the adverse reactions of drugs
and is able to prevent the occurrence of certain drug-induced diseases, and thirdly, the patient's disease is cured and
diseases are eliminated or alleviated to achieve the improvement of the patient's life Thirdly, the patient's disease can be cured, and the disease can be eliminated or alleviated, so as to improve the patient's quality of life and prolong the life of the fundamental purpose, fourthly, by
that the irrational use of medicines has been greatly reduced or eliminated, saving the resources of medicines, and thus reducing the cost of medical treatment, fifthly
that the pharmacist's status and image are improved, and at the same time, the income is increased.
China's clinical pharmacy work started late, as for pharmacy guardianship work is in the period of publicity. However,
China's irrational use of medication phenomenon is relatively common, certain grass-roots hospitals unqualified prescriptions up to 60% or more, the problem is very
serious. Pharmacovigilance is an inevitable trend in the development of hospital pharmacy in the 21st century.
6, China's implementation of the obstacles to pharmacy guardianship [3, 4, 5]
6, 1, conceptual barriers
6, 1, 1 beyond the pharmacist's traditional work to realize the "to ensure the quality of medicines and the supply of responsibility" to
"the patient is responsible for the results of medication. The pharmacist is difficult to adapt to this major shift in medication results, especially since current drug therapy decisions
are made by physicians and pharmacists do not have to take responsibility for them. With the implementation of pharmacovigilance, the pharmacist is authorized to participate in medication decisions,
responsible for monitoring the process of medication administration, observing the patient's response to the medication and making the necessary adjustments, tracking the final results of medication use,
and conducting the necessary evaluations.
6, 1, 2, Beyond the concept of curing disease as the goal PC provides services not only to cure the patient
of an existing disease, but also to restore the patient's health, so that the patient maintains good physical function and mental status
and lives a healthy and happy life.
6, 1, 3, beyond the biological indicators to evaluate the concept of treatment results now evaluate the results of drug treatment
indicators are only some of the observed data, for example, the use of anticancer drugs for cancer patients, to the patient's life
extension of the number of years for the evaluation of the treatment as an indicator of the good or bad. However, behind the pharmacologic effects of anticancer drugs, the amount of suffering (deterioration of quality of life) that patients
suffer due to serious toxic side effects of the drugs is not taken into account. To carry out
PC work, it is necessary to comprehensively evaluate the impact of drugs on the overall functioning of the patient, quality of survival and other indicators.
6, 1, 4, beyond the narrow geographical concept of specific medical institutions
6, 1, 5, beyond the current division of pharmacy business division of labor hospitals, all pharmacy staff, although the division of labor is different,
but the overall goal is the same, are drugs and pharmacy to provide patients with the means to improve the quality of life services.
6, 2, barriers in pharmacy resources
6, 2, 1, insufficient time At present, pharmacists in China have to spend a lot of time on the routine supply of medicines, that is,
even pharmacy pharmacists, who have the most contact with the clinic, have difficulty in focusing mainly on checking the room, attending meetings, reviewing the medical
records, drug counseling, drug monitoring, and recommending adjustments. In addition, pharmacists do not have enough time to
ensure that they read all patients' charts within 24h after administration of medication to detect problems with medication in a timely manner.
6, 2, 2, personnel constraints in China's hospitals, most of the pharmacy staffing is low, and the complexity of the staff structure,
coupled with a relative lack of clinical knowledge of the pharmacy staff, will not be able to carry out time-consuming and costly pharmacy monitoring work.
6,2,3 Limited workplaces and technical conditionsCurrently, China's hospital infrastructure has improved greatly,
but it does not yet have the conditions to set up a PC pharmacist's workplace in each clinical department.In addition, the current economic situation of the hospitals
generally do not have the conditions for the introduction of costly new technical equipment.
6, 3, obstacles in the health care system
The existing health care system is highly compartmentalized, and the coherence of pharmacy guardianship requires that the health care system be a complete body
System, which must be changed.
6,4,Barriers to information resources
6,4,1,Inadequate medical information Pharmacists providing pharmacovigilance services must not only have timely access to knowledge and up-to-date information about medications
, but more importantly must have access to the patient's medical documentation (past medical histories, medical history,
recordings, etc.), which is often not easily available to pharmacists. Therefore, the issue of ****enjoyment of medical information needs to be addressed.
6,4,2, Pharmacists lack experience in preparing medical documents Pharmacists' professional knowledge is biased towards the study of medications
and they lack clinical experience and skills.
6, 5, regulatory barriers
The traditional tasks of hospital pharmacists are mainly the procurement and supply of medicines and the receipt of prescriptions and the issuance of medicines, and pharmacists can only carry out business activities within their terms of reference under the conditions of regulatory licenses
. The implementation of the pharmacy guardianship business must be formulated in the Pharmacist Law and
added to the relevant regulations in the corresponding provisions.
7, pharmacy guardianship is imperative [1, 3]
Pharmacy guardianship is still in the publicity and introduction stage, the implementation of the difficulty, but pharmacy guardianship has been the pharmaceutical
Scientific community and the general concern of the hospital pharmacy staff. Reasons ① to carry out the objective conditions for the gradual formation of pharmacological monitoring, with
the improvement of people's living standards, health care, especially the requirements of the use of medication to improve the quality of treatment,
and even the quality of life of the height of the objective conditions for the gradual formation of this work; ② hospitals, the traditional supply of
pharmacy mode change, the pharmaceutical industry large-scale development of high quality, hospital preparations will gradually reduce, shrinking, and the hospitals will be the first time in the world. Hospital preparations will gradually reduce, shrink; Pharmacy
Department of modernization of the management, a fundamental change in the hospital's traditional mode of drug supply; ③ the use of computers, pharmacy staff surplus.
Therefore, if we do not think of reform and progress, stuck in the old ways, the fate of the "layoff" will fall on the traditional pharmacist
Head, people need pharmacy guardianship, pharmacy guardianship is also the next step in the hospital pharmacy staff out of the way. We should
start from updating their own concepts, correctly publicize pharmacovigilance, understanding of pharmacovigilance, consciously take the initiative to strengthen their own
study, adapted to the pharmacovigilance, for the implementation of pharmacovigilance in our country to clear all kinds of obstacles on the road, and strive to
create a pharmacovigilance gradually in-depth popularity, the development of a healthy environment.
The future of the hospital pharmacist should know both medicine and clinical understanding, its basic work content are: blood concentration monitoring
and interpretation, clinical treatment consulting and consultation, single-dose operation, patients discharged from the hospital after the use of drugs, education, outpatient patients
Personal drug counseling, drug adverse reaction monitoring and identification, new scientific research preparation development, participation in the clinical evaluation of new drugs
Program development. By utilizing the pharmacist's professional expertise, we can ensure ideal medication results and reduce medication-related
medical costs. As far as possible, every patient can maintain normal body function
and mental state after receiving medication, and live a healthy and happy life. [6]
References
Gao Shijia A new stage in the development of pharmacy--pharmacist's guardianship Chinese Journal of Pharmacy, 1995, 30(2): 97
Zhang Xinping, Guo Haiping, Yang Zhimin Pharmacological guardianship and clinical Chinese Journal of Hospital Pharmacy, 1996, 16(10): 469
Chen Qiuchao pharmacy supervision is an important content of clinical pharmacy Chinese Journal of Hospital Pharmacy, 1996, 16 (9): 393
Tang Jingbo drug pipe supply and use of supervision and guidance integration of Chinese pharmacy, 1998, 9 (5): 198-201
Hu Jinhong, Cai Qin the United States of America's pharmacy services Chinese Pharmacy, 1998, 9 (6): 283-285
Hu Jinhong, Cai Qin the United States of America's pharmacy services Chinese Pharmacy, 1998, 9 (6): 283-285
: 283-285Zhang Jun, Wei Shuiyi Hospital Pharmacy Work Model and Pharmaceutical Health Care Journal of Pharmacy Practice, 1995, 13(2): 114-118 Source: www.lw3721.com