缪丽燕医院药学未来发展共识简介终.ppt
医院药学未来发展共识简介,1,医院药学未来发展共识简介,苏州大学附属第一医院 缪丽燕,医院药学未来发展共识简介,2,2008年8月29日9月5日在瑞士巴塞尔召开会议主题：变革环境中再造药学实践 Reengineering Pharmacy Practice in a Changing World,世界药学大会（FIP）,医院药学未来发展共识简介,3,医院药学未来发展共识简介,4,第一届全球医院药学未来发展大会会议时间为：2008年8月30-31日地点：瑞士巴塞尔为FIP会议的一部分，来自98个国家的348名代表参加会议就医院药学实践问题成功达成六个方面74项共识,医院药学未来发展共识简介,5,医院药学未来发展共识简介,6,首先介绍了医院药学现状全球调研的背景、目的、方法及结果情况由六个工作小组分别对药品的采购、药品的处方、药品的配制与发放、药事管理、药物实践监测、医院药学的人力资源与培训调研等六个方面情况作报告,医院药学未来发展共识简介,7,会议又分成六个分组，分别对各报告进行讨论，形成初稿。最终共识讨论的初稿经过代表投票表决形成最终的共识，合计74条（总共识13条、分共识61条）。为医院药师应该做什么，应该怎么做，绘制了清晰的蓝图。,医院药学未来发展共识简介,8,提纲,医院药学未来发展共识的产生医院药学未来发展共识内容简介,医院药学未来发展共识简介,9,共识产生的基础,医院药学实践全球调查目的：1.对全球医院药学实践进行调查，了解全球医院药学的现状和全球医院药学实践的范围2.建立医院药学实践全球性的基本标准3.为未来医院药学规划提供基础,医院药学未来发展共识简介,10,医院药学实践全球调查,方法：设计调查表，一共75个问题，包括两个类型的情况调查（范围、现状）结果：调查报告回收到 85个国家（44），代表全球人口的86,医院药学未来发展共识简介,11,国内有12家医院参加，包括北京、广州、广西、上海、昆明、苏州、新疆、重庆、辽宁等。,医院药学未来发展共识简介,12,以“患者用药安全为中心”的“共识”,涵盖了药品在医院使用过程的六个方面。1.药品的采购（10条）2.药品的处方（8条）3.药品的配制与发放（9条）4.药事管理（16条）5.药物实践监测（8条）6.医院药学的人力资源与培训调研（10条）,医院药学未来发展共识简介,13,总 共 识,1.The overarching goal of hospital pharmacists is to optimize patient outcomes through the judicious,safe,efficacious,appropriate,and cost effectiveuse of medicines.医院药师共同目标是通过合理、安全、有效、适当和经济的用药来优化患者的治疗结果。,医院药学未来发展共识简介,14,2.At a global level,Good Hospital Pharmacy Practice guidelines based on evidence should be developed.These guidelines should assist national efforts to define standards across the levels,coverage,and scope of hospital pharmacy services and should include corresponding human resource and training requirements.应在全球范围内,以循证为基础制订“优良医院药房规范GPP”指南，此指南应有助于各国制定的医院药学实践的水平、内涵及范围等，并应包括相关的人力资源和培训需求。,总 共 识,医院药学未来发展共识简介,15,3.The five rights(the right patient,right medicine,right dose,right route,and right time)should be fulfilled in all medicines-related activities in the hospital.医院中的与药物使用相关的任何环节都应该实现“五个正确”（正确的患者、正确的药品、正确的剂量、正确的给药途径和正确的时间）。,总 共 识,医院药学未来发展共识简介,16,4.Health authorities and hospital administrators should engage hospital pharmacists in all steps in the hospital medicines-use process.卫生行政部门和医院管理者应鼓励药师参与医院用药过程的各个环节。,总 共 识,医院药学未来发展共识简介,17,5.Health authorities should ensure that each hospital pharmacy is supervised by pharmacists who have completed specialized training in hospital pharmacy.卫生行政部门应确保每个医院药房都由完成了医院药学专门培训的药师进行监督指导。,总 共 识,医院药学未来发展共识简介,18,总 共 识,6.The Chief Pharmacist/Director of Pharmacy should be the senior professional responsible for co-ordinating the judicious,safe,efficacious,appropriate,and cost effective use of medicines in the hospital.药房主管/药房主任应由高级执业人员担任，对医院用药的合理、安全、有效、适宜和经济负有责任。,医院药学未来发展共识简介,19,7.Hospital pharmacists should take responsibility for all medicines logistics in hospitals.医院药师应对医院所有的药品保障工作负有责任。,总 共 识,医院药学未来发展共识简介,20,总 共 识,8.Hospital pharmacists should serve as a resource regarding all aspects of medicines use and be accessible as a point of contact for health care providers.就药品使用相关的各个方面而言，医院药师应作为信息的提供者；当医护人员需要的时候，也应能随时找到医院药师。,医院药学未来发展共识简介,21,9.All prescriptions should be reviewed,interpreted,and validated by a hospital pharmacist prior to the medicine being dispensed and administered.所有的处方在调配、服用前，都应经过医院药师的审核、解释和认可。10.Hospital pharmacists should be allowed to access the full patient record.医院药师应有权查阅患者的所有病历资料。,总 共 识,医院药学未来发展共识简介,22,11.Hospital pharmacists should provide orientation and education to nurses,physicians,and other hospital staff regarding best practices for medicines use.医院药师应对护士、医生和其他医院工作人员提供关于用药最佳实践的指导和教育。,总 共 识,医院药学未来发展共识简介,23,总 共 识,12.Undergraduate pharmacy curricula should include hospital-relevant content,and post-graduate training programs and specializations in hospital pharmacy should be developed.本科药学学生课程应包含医院药学相关内容，并应建立毕业后培训项目和医院药学专科培训。,医院药学未来发展共识简介,24,总 共 识,13.Hospital pharmacists should actively engage in research into new methods and systems to improve the use of medicines.医院药师应主动参与研究新方法和新系统，以促进药品使用。,医院药学未来发展共识简介,25,调查结果总情况：全球差异大、影响受其他因素影响、药师影响非常广泛、向临床药学实践方向发展,共识2 对处方的影响（8条）,医院药学未来发展共识简介,26,医院药学未来发展共识简介,27,共识2 对处方的影响,24.Hospitals should utilize a medicine formulary system(local,regional,and/or national)linked to standard treatment guidelines,protocols,and treatment pathways based on the best available evidence.医院应使用基于最易获得的、与标准治疗指南、方案和治疗途径相对应的药品处方集系统（当地的、地区性的和/或国家的）。,医院药学未来发展共识简介,28,25.Hospital pharmacists should be members of pharmacy and therapeutics committees to oversee all medicines management policies and procedures,including those related to off-label use and investigational medicines.医院药师应是药事和治疗学委员会的成员，以监察所有的药品管理政策和程序，包括那些与非标签用法和临床试验研究药物有关的内容。,共识2 对处方的影响,医院药学未来发展共识简介,29,26Hospital pharmacists should take every opportunity to educate prescribers at all levels of training about medicines.医院药师应抓住一切机会对各层次的处方人进行与药物相关的教育培训。,共识2 对处方的影响,医院药学未来发展共识简介,30,27Hospital pharmacists should have a key role in educating prescribers on the access to and evidence for optimal and appropriate use of medicines,including the required monitoring variables and prescribing adjustments.医院药师在培训处方人对药品最优、适宜的使用和循证方面应起到重要作用，包括所需的监测参数和处方调整。,共识2 对处方的影响,医院药学未来发展共识简介,31,共识2 对处方的影响,28 Hospital pharmacists should be involved in all patient care areas to prospectively influence collaborative therapeutic decision-making.医院药师应介入对患者服务的所有领域，以期对合作性治疗决策的制定产生影响。,医院药学未来发展共识简介,32,共识2 对处方的影响,29 Hospital pharmacists should be an integral part of all patient rounds to assist with therapeutic decision-making and advise on clinical pharmacy and patient safety issues.医院药师应成为每位患者的治疗整体中的一个部分，协助制定治疗决策，给出临床药学以及患者安全方面的建议。,医院药学未来发展共识简介,33,共识2 对处方的影响,30Hospital pharmacists should provide continuity of care by transferring patient medicines information as patients move between sectors of care.当患者转换治疗区域时，医院药师应移交患者用药信息，以保障药学实践的连续性。,医院药学未来发展共识简介,34,共识2 对处方的影响,31.Postgraduate clinical courses should be developed to prepare hospital pharmacists for collaborative prescribing of medicines,including instruction in legal and professional accountability;this role of hospital pharmacists should be promoted in the curricula of other health professionals.应制定研究生课程来培养医院药师，为协作开方做准备，包括法律和专业的责任方面的建议。医院药师的这种作用也应该加入到其它医疗专业课程中去。,医院药学未来发展共识简介,35,共识3 调配与配发（9条）,医院药学未来发展共识简介,36,共识3 调配与配发,32.Hospital pharmacists should ensure that proper storage conditions are provided for all medicines used in the hospital.医院药师应确保为院内的所有药品提供合适的贮存条件。33.Hospital pharmacists should assume responsibility for the control of medicines stored throughout the hospital.医院药师应负责院内药品贮存的质量控制。,医院药学未来发展共识简介,37,审方,药师审方对保证药物治疗的安全有效非常重要在全球调研中，全球一半医院做得不充分。,医院药学未来发展共识简介,38,药物配置,无菌与安全的技术对于配置药品是需要的在全球调研中，这一技术正在发展阶段,医院药学未来发展共识简介,39,共识3 调配与配发,34.Hospital pharmacists should ensure that compounded medicines are consistently prepared to comply with quality standards.医院药师应确保提供的复配药品始终符合质量标准。35.Hospital pharmacists should provide pharmacy-managed injectable admixture services using aseptic technique.医院药师应采用无菌技术提供药房配制的注射用混合液配置服务。,医院药学未来发展共识简介,40,共识3 调配与配发,36.Hazardous medicines including cytotoxics should be prepared under environmental conditions that minimize the risk of contaminating the product and exposing hospital personnel to harm.危险药品，包括细胞毒性药品等的配制，应在使药品的污染和对工作人员的暴露风险降到最低的环境条件下进行。,医院药学未来发展共识简介,41,药师参与监护情况,高危药品常常在急诊及手术室使用在全球调研中可见，药师参与急诊用药是不够的,医院药学未来发展共识简介,42,在调配过程中使用信息及计算机系统,使药学实践更有效，新技术的使用是需要的在全球调研中可见，自动化及信息系统的使用是不够的,医院药学未来发展共识简介,43,共识3 调配与配发,37.Hospital pharmacists should decrease the risk of medication errors by implementing evidence-based systems or technologies,such as automated prescription-filling,unit dose distribution,and bar coding systems.医院药师应通过实施循证系统或技术来减少用药差错的风险，例如自动化处方填写、单剂量药品调剂以及条形码系统。,医院药学未来发展共识简介,44,38.Hospital pharmacists should support the development of policies regarding the use of medicines brought into thehospital by patients,including the evaluation of appropriateness of herbal and dietary supplements.医院药师应支持制定关于患者自备药的使用方面的政策，包括对草药和膳食补充剂的适应性评价。,共识3 调配与配发,医院药学未来发展共识简介,45,39.Hospital pharmacists should assume responsibility for storage,preparation,dispensing,and distribution of investigational medicines.医院药师应负责临床试验研究药物的贮存、准备和调剂。,共识3 调配与配发,医院药学未来发展共识简介,46,共识3 调配与配发,40.Hospital pharmacists should implement systems for tracing medicines dispensed by the pharmacy(to facilitaterecalls,for example).医院药师应实施药房的药品调剂跟踪系统（例如药品召回）。,医院药学未来发展共识简介,47,共识 5 药物实践监测,结果监测：对药物治疗效果、ADR及ADE报告与学习系统、所用药物的费用过程监测：对缺陷药物、发药差错、医院药物的使用、处方等报告与学习系统自身监测：外界对药学实践的评价、药学实践的自我评价,监测的角度：,医院药学未来发展共识简介,48,共识 5 药物实践监测,57 A reporting system for defective medicines should be established and maintained to monitor and take the necessary action to minimize identified risks.Reports of defective or substandard medicines should be sent to regional or national pharmacovigilance reporting programs where these are available.应建立和维护缺陷药品报告系统，以便监测和采取必需的措施使可识别的风险最小化。如果可行，应将缺陷药品和不合格药品的报告报送到地区或国家药物警戒报告中心。,医院药学未来发展共识简介,49,共识 5 药物实践监测,58A reporting system for adverse drug reactions should be established and maintained,and the necessary action should be taken to minimize identified risks.Reaction reports should be sent to regional or national pharmacovigilance reporting programs where these are available.应建立和维护药物不良反应报告系统，应采取必要的措施使可识别的风险最小化。如果可行，应将不良反应报告报送到地区或国家药物警戒报告中心。,医院药学未来发展共识简介,50,共识 5 药物实践监测,59A reporting system for medication errors should be established and maintained,and the necessary action should be taken to minimize identified risks.Reports of medication errors should be sent to regional or national medication error reporting programs where these are available.应建立和维护用药差错报告系统，应采取必要的措施使可识别的风险最小化。如果可行，应将用药差错报告报送到地区或国家药物警戒报告中心。,医院药学未来发展共识简介,51,共识 5 药物实践监测,60Hospital medication practice should be self assessed and data trended internally and compared with best practice in other institutions to improve safety,clinical effectiveness,and cost effectiveness.医院用药实践应有内部数据并进行自我评估，应与其它机构的优良规范进行比较，以提高安全性、临床有效性和成本效益。,医院药学未来发展共识简介,52,共识 5 药物实践监测,61Hospital medication practices should be reviewed by an external quality assessment accreditation program.Hospitals should act on reports following regular external quality assessment inspections to improve the quality and safety of their practices.医院用药实践规范应由外部质量评估鉴定机构进行审查。医院应根据外部质量评估机构定期检查的结果来提高其规范的质量和安全性。,医院药学未来发展共识简介,53,共识 5 药物实践监测,62.Pharmacists clinical interventions should be documented in the patient record.These data should be regularly analyzed to improve the quality and safety of medication practice.药师进行的临床干预应在患者病历中有记录。应定期分析这些资料以提高用药实践的质量和安全性。,医院药学未来发展共识简介,54,共识 5 药物实践监测,63 Trigger tools should be used to provide quantitative data on adverse drug events in the hospital.These data should be regularly reviewed to improve the quality and safety of medication practices.应使用触发工具来提供医院药物不良反应的数据资料。这些数据应定期审查，以提高用药实践的质量和安全性。,医院药学未来发展共识简介,55,共识 5 药物实践监测,64 Advanced clinical pharmacy services should manage medication therapy to optimize therapeutic outcomes.Outcomes data from such programs should be regularly reviewed and used to improve the quality and safety of medication practices.Examples include management of anticoagulation therapy,antimicrobial therapy,and therapeutic drug monitoring.高级临床药学实践应对药物治疗进行管理以使治疗结果最优化。治疗结果数据应定期审查，以提高药学实践的质量和安全性。例如对抗凝治疗、抗菌药物治疗和治疗药物监测的管理。,医院药学未来发展共识简介,56,所有大会达成的共识，包括相应支持这些共识的文献，将于2009年早期在美国医院药师协会杂志的增刊上发表。,医院药学未来发展共识简介,57,谢 谢！,医院药学未来发展共识简介,58,共识4 管理,38%of preventable medication errors occur at the administration stepEstimated that hospitalized patients experience at least 1 medication error per day56.5%of reported errors associated with severe harm or death occur at administration stepNurses spend up to 40%of their time administering medications,
