The Exploration Of Pharmaceutical Care Mode Carried By Pharmacists In Neurology Department Of A Hospital

In our previous medical model, the hospital pharmacists in pharmacies,preparation rooms and other positions were mainly engaged in pharmaceuticaldispensing work and preparation work, but there were disjointed situation betweenpharmaceutical technical service and clinical circumstances. In recent years, due tothe energetic efforts of the Ministry of Health, pharmaceutical service model has beendramatically changed; some clinical pharmacists have shifted from drug dispensingand preparation work to clinical work. And as clinical pharmacists, they have beenparticipated in the clinical treatment team and focused on guiding rational drug useinstead of drug supply. In2008our country started clinical pharmacist system project,which became a strong impetus to carry out our work in clinical pharmacy. Ourhospital also became one of the pilots in Clinical Pharmacy system. In order to meetthe needs of hospitals and social development, our hospital clinical pharmacists areactively occupied in clinical pharmacy work. After years of exploration andaccumulation of experience, they have worked out clinical pharmaceutical servicemodel in neurology to realize the rational use of drugs.Objective: Clinical pharmacists carried out pharmaceutical care in neurology inorder to ensure patients treated under the optimization scheme and the minimum risk,also to improve patient satisfaction on medical service and to achieve the purpose ofsafety, effective and reasonable use of drugs. Method: Our hospital carried out specialized clinical pharmacists and weparticipated in clinical pharmaceutical care in neurology. Many factors can increasethe incidence of adverse drug reactions in the treatment, such as complex diseases,elderly patients, underlying health problems and drug combination. Clinicalpharmacists figured out medication service model by several years of practice.Pharmaceutical care promoted rational drug use from three respects: physicians,nurses and patients.1. Pharmaceutical care of patientsClinical pharmacists made pharmaceutical ward round for the first time carryingadmission information registration form, and learnt about the details about the historyof diseases, medication history, and other related information (psychological status,economic conditions, and etc.) of the patients. We conducted the evaluation ofmedication compliance to the patients according to drug-using status formerly. Thestandards were as follows. It was evaluated as well that the patients took medicinefollowed by doctors’ advice completely (the time of medication use, dose, method,approach, frequency, period of treatment). It was evaluated as poor that the patientsmight autonomously change the medication three or more times, refused to take drugs,added the medicine autonomously or missed taking drugs out of prescription. Otherswere in the medium. We divided the patients of poor compliance into four types: thepatients who used drugs cautiously, the ones who addicted to drugs, the ones whotook drugs carelessly and the ones who had some medical knowledge. Weimplemented individualized medication education according to the different types ofpatients.We have evaluated the risk factors of patients, and inclusion criteria were (1)patients were older than70,(2) more than two kinds of basic disease (hypertension,hyperlipemia, diabetes, coronary heart disease and etc.),(3) patients with liver and kidney dysfunction,(4)relevant laboratory index (coagulation,electrolyte) were out of scope. Individual patient who were fitted into the criteriawere under pharmaceutical care, and aiming at patients with aging or innormal testingresults etc., to evaluate the drugs which caused innormal laboratory results andadverse effects in patients and providing medication adjustment suggestionsfor physicians.Clinical pharmacists practiced adverse drug reaction monitoring of patients. Oncepatients appeared or were suspected of adverse drug reactions in the process of druguse, we would provide suggestions for the physicians in order to avoid the harm ofpatients caused by adverse drug reactions.2. Pharmaceutical services for doctorsAs clinical pharmacists, they should make the rounds of the wards in a hospitaltogether with clinicians, involve in formulate therapy program and examineprescription. Meanwhile, they make suggestions and comments on drug-related issuesaccording to the patients’ treatment and summarize the dosage and precautions ofspecific drugs to make reference materials for physicians. Moreover, they also needassist physicians in deal with the problem of drug therapy for special cases.3. Pharmaceutical services for nursesAnother duty for them is to guide and help teach nurses about special drugincompatibility and precautions on infusion solution (dark, drip). On the other hand,the quality of patient specimens is closely related to the accuracy of the experimentalresults, however, nurses are responsible for collecting specimens and censorshipdirectly or indirectly. So clinical pharmacists ought to guide nurse to collect to ensurespecimen qualified in shift time.Result: Clinical pharmacists in the neurology to carry outmedication service model, is conducive to the development of rational drug use through service for1061patients in2013.Medication compliance of patients was improved compared to that of beforeadmission. Patient compliance was poor before admission, only680patients hadgood compliance. Through the individualized education, patients with goodmedication compliance achieved949with the increase of269compared to that ofbefore admission. Clinical pharmacists conducted risk assessment and774patientsgot individualized care.265treatment recommendations for physicians were providedby clinical pharmacists and the adoption rate was70%. We have analyzed of67patients with adverse reactions, and prompted suggestions for physicians includingdiscontinuing or replacing therapy drug treatment. Then58patients cured,10patientsbecame well.Within the clinical pharmacists modeling of services, the hospital stay of patientshas decreased to11.62in2013compared to11.97days in2012. Medicine accountedwas reduced2.32in2013. In addition, the rational application of antimicrobial agentsin the neurology have been improved, the antimicrobial usage in2013wasdramatically decreased to7.14%compared to25.66%in2012. The intensity of theantibacterial drug use was reduced to14.72compared to21in2012.In the process of drug treatment, clinical pharmacists provided individualizedpharmaceutical care to patients and strengthened the guidance on rational drug use tomedical staffs. The investigation result showed that clinical pharmacists have carriedout pharmaceutical care mode in the neurology department which helped therealization of clinical rational drug use.