Good news! Pharmacists can sit in the clinic, write prescriptions and have a "registration fee"!

Recently, Guangdong Pharmaceutical Society issued "Trial Standards for Pharmacy Outpatients". Pharmacists can not only sit in the pharmacy clinic, but also have some prescription rights and "registration fees"! Let's take a look at the detailed document notice! With the gradual advancement of comprehensive reform measures in public hospitals, pharmaceutical services in medical institutions are facing new opportunities and challenges. In order to meet the requirements of reform, further strengthen pharmaceutical affairs management, promote the transformation of pharmaceutical service mode and safeguard people's health rights and interests. The practice in developed countries has proved that pharmacists can directly provide pharmaceutical services to patients by setting up pharmaceutical clinics, which has a significant effect on improving the level of drug treatment and reducing the cost of drug treatment. It is of great significance to carry out pharmacy outpatient service to accelerate the development of clinical pharmacy and help the transformation of hospital pharmacy. In order to promote and standardize the healthy development of pharmaceutical clinics in medical institutions, the following trial standards are put forward. I. Policy Basis Providing services directly to patients through outpatient service is an important breakthrough point for pharmacists to improve their clinical core competitiveness. The Notice of the National Health and Family Planning Commission on Strengthening Pharmaceutical Affairs Management and Changing Pharmaceutical Service Mode (Guo Wei Ban Yi Fa [2065438+07] No.26) suggests that qualified medical institutions can set up pharmacist consultation clinics to provide patients with medication consultation and guidance; One of the indexes of pharmaceutical service ability stipulated in the National Regional Medical Center (General Hospital) is that the number of patients served by "pharmaceutical outpatient service" is greater than or equal to 200 per year; The Evaluation Index of High-level Hospitals (General Hospitals) in Guangdong Province issued by the Guangdong Provincial Health Planning Commission requires pharmacy outpatient service to be ≥2 majors; In order to promote medical institutions to carry out pharmacy outpatient service, Guangdong Pharmaceutical Society issued the Notice on Promoting Pharmacy Outpatient Service in April 20 17 (Guangdong Pharmaceutical Society [2065438+07] No.26). Second, the purpose of setting up pharmacy outpatient service is to improve the results of patients' drug treatment: 1. Clinical results: Pharmacists in pharmacy outpatient department can improve patients' medication compliance and therapeutic effect, and reduce the occurrence of adverse reactions by guiding patients to take drugs and conducting follow-up and pharmaceutical care. 2. Humanistic achievements: pharmacists in pharmacy outpatient department provide humanistic care for patients and improve their satisfaction with drug treatment; 3. Economic Outcome: Pharmacists in pharmacy outpatient department can reduce drug-related damage and unnecessary drug treatment by collecting patients' medication information and recombining drugs, and reduce the economic burden of medical insurance departments and patients' disease treatment. Third, the hardware requires a fixed clinic in the outpatient building. There are regular visiting hours every week. The outpatient computer is equipped with outpatient medical system, inpatient medical record system and pharmacy system, which can query the diagnosis, examination, inspection, medication and other information of patients' outpatient and hospitalization. Conditional medical institutions should be equipped with pharmacists' workstations to manage patients' files. Four. Job Requirements and Responsibilities: Clinical pharmacists in pharmacy outpatient department should be trained by clinical pharmacists in a standardized way, and obtain the post training certificate of clinical pharmacists, or have the qualification certificate of Drug Treatment Management certified by Guangdong Pharmaceutical Society, or have the senior professional title qualification to engage in clinical pharmacy for 2 years. Responsibilities mainly include: collecting and establishing patient medication management files, including current medical history, past medical history, medication history, allergy and adverse reaction history; Living habits and diet; Birth, surgical plan, etc. Organize the current medication situation and make personal medication records, including prescription drugs/over-the-counter drugs, Chinese herbal medicines, health care products, etc. In order to facilitate the family medication management of patients and provide medication information to other medical staff when seeking medical treatment. Evaluation of drug treatment efficacy and adverse drug reactions and other related issues; In view of the problems existing in patients' current drug treatment, appropriate intervention should be carried out, such as prescription simplification, drug reorganization and/or lifestyle adjustment or dietary improvement suggestions, or communication with the patient's attending physician for drug treatment intervention. Provide individualized medication education to enhance patients' understanding of drugs and enable them to use drugs correctly. Pharmacists in pharmaceutical clinics should actively participate in clinical teams, understand the current clinical treatment status of medical institutions through domestic and foreign guides, knowledge and literature, master the latest disease treatment methods, and improve pharmaceutical outpatient work in practice. 5. Customers and publicity of patients suffering from one or more chronic diseases and receiving multi-system and multi-professional treatment at the same time; Such as chronic kidney disease, hypertension, coronary heart disease, hyperlipidemia, diabetes, gout, asthma, chronic obstructive pulmonary disease, osteoporosis, peptic ulcer and other diseases; Patients who are taking high-risk drugs, including anticoagulants, phenytoin sodium, methotrexate and other drugs for the treatment of window stenosis; Patients taking 5 or more drugs at the same time (including prescription drugs and over-the-counter drugs, Chinese herbal medicines and other health care products); Special groups such as the elderly, children, pregnant women and lactating women; Abnormal laboratory examination, these abnormal suspicious patients are related to drugs; Patients with recent adverse medical events (drug-related or non-drug-related) while receiving treatment; Patients who have doubts about drug treatment. The promotion forms of patients can be diversified, such as: referral by doctors or other medical personnel; Educate patients who take medicine in pharmacy or leave hospital, and distribute leaflets; Publicity by public media, popularization of pharmaceutical science, etc. Sixth, the solution of prescription right Because pharmacists have no prescription right, it is an effective way to solve the prescription right of pharmacists by reaching an agreement with doctors abroad. In developed countries such as Europe and America, pharmacists are mainly responsible for antithrombotic work, while in antithrombotic (anticoagulant) clinics, pharmacists directly adjust prescriptions for patients. Domestic medical institutions have reached an agreement with doctors to realize the problem that pharmacists have the right to directly adjust prescriptions for patients (recommended text of the agreement between pharmacists and doctors on antithrombotic therapy, Guangdong Pharmaceutical Association [20 17] 15). It is suggested that pharmacists in pharmacy outpatient department should be given some prescription authority (such as issuing inspection and audit authority), which should be examined and filed by the medical department. Seven. Types of outpatients At present, domestic medical institutions have set up independent pharmacy clinics or combined pharmacy clinics according to the characteristics and needs of their own specialty development. Outpatient types include anticoagulation treatment management outpatient service, atrial fibrillation outpatient service, accurate medication outpatient service based on medication management, pharmacy outpatient service for specialized patients, such as respiratory patients outpatient service, pharmacy outpatient service for chronic obstructive pulmonary disease and asthma, menopause combined outpatient service, and medication for special groups (pregnant women, children, the elderly, etc.). ). Eight. Charging Standard 20 13 The World Pharmaceutical Congress clearly stated that pharmaceutical services without payment are unsustainable. And from the historical experience of developed countries, reasonable fees are an inevitable requirement for the benign and sustainable development of professional and technical services. The United States has incorporated drug treatment management services into the government medical insurance Medicare D plan. In order to ensure the sustainable development of pharmaceutical services, each medical unit should set up a fee-paying pharmacy clinic, or set up a free pharmacy clinic first to realize the final fee (Notice on Promoting the Work of Pharmacy Clinic [2017] No.26). It is suggested that outpatient pharmacy charges refer to the existing pharmacy service charges. Nine. The service content refers to the American drug treatment management model (MTM), and combined with the actual situation of medical institutions in China, the content of pharmaceutical outpatient service is: 1. Review of drug therapy. Establish patient information files (the specific work form depends on the work content, such as work records related to chronic disease management, see Schedule 2), review medical history and medication history, and evaluate drug treatment and adverse drug reactions and other related issues. 2. Make a personal medication record (PMR) for patients. Organize the current medication situation and make a personal medication record (Table 3), including prescription drugs/over-the-counter drugs, Chinese herbal medicines, health care products, etc. In order to facilitate the family medication management of patients and provide medication information to other medical staff when seeking medical treatment. 3. Propose an action plan (MAP) related to drug treatment. According to the problems (medication-related problems, MRPs) existing in patients' current medical treatment (Appendix 1), or the lifestyle or diet that needs to be adjusted, take appropriate intervention measures, such as prescription simplification, drug reorganization and/or lifestyle adjustment or dietary education suggestions, and talk with them when necessary. 4. Provide individualized medication education to enhance patients' understanding of drugs and enable them to use drugs correctly. 5. Answer patients' questions about medication. 6. Follow-up visit, follow-up medication, and make an appointment for follow-up. X. Admission process The admission process of the pharmacy clinic is as follows (Figure 1): 1. First-time patients: ① patient information collection: establish patient information files, and the basic information includes; Current medical history, past medical history, medication history, allergy history and adverse reaction history; Living habits and diet; Birth, surgical plan, etc. (2) Evaluation of medication scheme: Evaluate the medication scheme, curative effect and whether there are any adverse reactions for each disease; Assess whether patients have problems related to drug treatment (attached table1); Assess patients' knowledge and compliance with diseases and drugs. ③ Medication intervention: In view of medication-related problems, make appropriate interventions, such as prescription simplification and drug reorganization, and communicate with the patient's attending physician when necessary. Make a personal medication record table to facilitate the patient's family medication management, and provide medication information to other medical staff when seeking medical treatment. ④ Medication education: individualized medication education, lifestyle adjustment suggestions and diet education were given to patients, and relevant publicity materials were distributed. ⑤ Verify patients' understanding and acceptance of pharmacists' suggestions, and investigate their satisfaction. ⑥ Sort out the data and input it into the computer, regularly check the patient's examination results and new prescriptions, follow up by telephone and make an appointment for the next visit. 2. Non-newly-diagnosed patients: call up the patient information file, and re-evaluate the drug-related problems according to the patient's disease and medication changes (starting from item 2 in 1 above). Attachment download1-3 > & gt attachment 1: categories and common causes of drug-related problems (MRPs) attachment 2: pharmaceutical outpatient record form attachment 3: patient medication list.