導(dao)語：全程(cheng)化(hua)藥(yao)學服務(wu)轉型體系(xi)的構建一文來(lai)源于網友上傳，不代表本(ben)站(zhan)觀(guan)點，若需要(yao)原創(chuang)文章可咨詢客(ke)服老(lao)師(shi)，歡迎參考。

[摘要]隨著醫改進(jin)入(ru)關(guan)鍵時期,藥(yao)學服(fu)(fu)務(wu)的(de)(de)(de)順(shun)利(li)轉(zhuan)型已成為醫療機(ji)構管(guan)理(li)關(guan)注(zhu)的(de)(de)(de)重點,如何成功(gong)實(shi)(shi)施藥(yao)學服(fu)(fu)務(wu)轉(zhuan)型成為亟須解(jie)決的(de)(de)(de)問題。為盡(jin)快實(shi)(shi)現該目標(biao),作(zuo)者(zhe)全面(mian)概括了(le)轉(zhuan)型過程存在(zai)的(de)(de)(de)矛盾,詳細列舉了(le)轉(zhuan)型方向及該院(yuan)轉(zhuan)型的(de)(de)(de)實(shi)(shi)踐(jian)情況,從理(li)論到實(shi)(shi)踐(jian)多方面(mian)證實(shi)(shi)了(le)該轉(zhuan)型思(si)路的(de)(de)(de)可行性(xing)。

[關鍵詞]藥學服(fu)務;醫院藥學;轉型;體系

國家已出臺一系列政策鼓勵藥學專業人員轉型。2017—2020年的相關發文明確要求,藥師應以合理用藥為核心,需加大處方審核和點評力度。這一系列國家政策不僅為發揮藥師專業價值提出了新要求,也對藥師隊伍的建設提出了新挑戰。本院處于青藏高原地區,受人文環境、經濟等多方面影響,藥學發展相對落后,藥學服務轉型目標不明確,轉型政策落實不到位。在此背景下,作者通過多年摸索和實踐,對比新舊藥學服務發展的區別,找出其中的矛盾點,明確藥學服務轉型目標,構建出以全程化藥學服務為基礎的藥學服務轉型體系[1]。

1藥學服務實施過程中存在的矛盾

隨著醫改進入關(guan)鍵時(shi)期(qi),藥(yao)學(xue)服(fu)務(wu)(wu)的順利(li)轉型已(yi)成(cheng)(cheng)為(wei)醫院(yuan)管理關(guan)注的重點(dian)。為(wei)了(le)順利(li)將(jiang)藥(yao)學(xue)服(fu)務(wu)(wu)轉型從(cong)“藥(yao)事(shi)(shi)管理”升(sheng)級成(cheng)(cheng)“要事(shi)(shi)”[2],作者通(tong)過文獻調(diao)查(cha)及實(shi)踐,總結出以下4個(ge)矛盾點(dian)。(1)院(yuan)校教育:藥(yao)學(xue)專業(ye)院(yuan)校教育與臨床(chuang)(chuang)(chuang)(chuang)實(shi)際情(qing)況脫節,學(xue)生入職后缺(que)乏(fa)系統化培訓,導致藥(yao)學(xue)人員輸(shu)出、輸(shu)入不匹配。(2)專業(ye)水平:專業(ye)水平有限,無(wu)法(fa)為(wei)醫護人員及患者提供所(suo)需的藥(yao)學(xue)服(fu)務(wu)(wu)。(3)臨床(chuang)(chuang)(chuang)(chuang)溝(gou)(gou)通(tong):獨自發展,與臨床(chuang)(chuang)(chuang)(chuang)醫護人員缺(que)乏(fa)有效溝(gou)(gou)通(tong)與交流,藥(yao)學(xue)服(fu)務(wu)(wu)意識不強,無(wu)法(fa)與臨床(chuang)(chuang)(chuang)(chuang)形成(cheng)(cheng)合力(li),也(ye)無(wu)法(fa)有效助力(li)臨床(chuang)(chuang)(chuang)(chuang)合理用藥(yao)。(4)科(ke)(ke)研(yan)能(neng)力(li):科(ke)(ke)研(yan)能(neng)力(li)不強,論(lun)文及課題質量不高,無(wu)法(fa)將(jiang)臨床(chuang)(chuang)(chuang)(chuang)問(wen)題有效轉化為(wei)科(ke)(ke)研(yan),不能(neng)形成(cheng)(cheng)臨床(chuang)(chuang)(chuang)(chuang)-基(ji)礎科(ke)(ke)研(yan)互助的可持續化良性發展循環。

2藥學服務成功轉型亟須解決的問題

通過對文(wen)獻調研[3-5]及現(xian)(xian)狀(zhuang)調查得知,若要(yao)(yao)成功(gong)轉型藥(yao)(yao)學服務,需(xu)要(yao)(yao)解(jie)決4個(ge)較(jiao)(jiao)(jiao)為(wei)關(guan)鍵的(de)問題。(1)藥(yao)(yao)師專業技(ji)術(shu)水平有(you)待提升,學習積極性較(jiao)(jiao)(jiao)差(cha),團隊凝(ning)聚力較(jiao)(jiao)(jiao)弱;藥(yao)(yao)師績效考核管理(li)機制(zhi)有(you)待進一(yi)(yi)(yi)步完善。(2)現(xian)(xian)有(you)醫囑(zhu)審(shen)核結果比較(jiao)(jiao)(jiao)淺顯,急需(xu)成立“藥(yao)(yao)師+智(zhi)慧軟件(jian)”的(de)審(shen)方中(zhong)心工(gong)(gong)作(zuo)模(mo)式(shi),為(wei)患者用藥(yao)(yao)安全(quan)助力。(3)傳統調劑工(gong)(gong)作(zuo)模(mo)式(shi)單(dan)一(yi)(yi)(yi),工(gong)(gong)作(zuo)簡單(dan)且耗時較(jiao)(jiao)(jiao)長,需(xu)要(yao)(yao)自動化及一(yi)(yi)(yi)體化的(de)新型調劑模(mo)式(shi),將時間還給藥(yao)(yao)師,讓其用于合理(li)用藥(yao)(yao)質量把控。(4)藥(yao)(yao)師在治療過程(cheng)參與(yu)感弱,存在感低,在日常工(gong)(gong)作(zuo)中(zhong)需(xu)要(yao)(yao)從(cong)“幕后工(gong)(gong)作(zuo)”走向(xiang)“臺前”。

3藥師服務的轉型方向思考

本院針(zhen)對(dui)以上(shang)調(diao)研轉型中(zhong)存在的(de)問題(ti),結合醫(yi)院藥學(xue)發展現狀及能力,提(ti)出了相(xiang)應的(de)轉型方向思考(kao)(kao)。針(zhen)對(dui)專業(ye)技術水平(ping)有待提(ti)升、學(xue)習積(ji)極性較差等問題(ti),考(kao)(kao)慮加強藥師隊伍建(jian)設(she),促進多角色(se)藥師發展;針(zhen)對(dui)醫(yi)囑(zhu)審核比較淺(qian)顯的(de)問題(ti),考(kao)(kao)慮采(cai)用“藥師+智(zhi)慧軟件(jian)”的(de)審方模式助力醫(yi)囑(zhu)審核;針(zhen)對(dui)傳統調(diao)劑工作模式單一、工作簡單且耗時較長等問題(ti),通過引(yin)進智(zhi)能化設(she)備(bei),確保高效精準調(diao)配;針(zhen)對(dui)在治療過程中(zhong)參(can)與感(gan)弱、存在感(gan)低的(de)問題(ti),考(kao)(kao)慮加強用藥教(jiao)育和藥學(xue)科普,不斷擴大服(fu)務受眾群體。

3.1加強藥師隊伍建設(she)

隨著臨床知(zhi)識的(de)(de)(de)(de)持續發展及工作中(zhong)需(xu)(xu)求的(de)(de)(de)(de)不斷增加,臨床對(dui)藥(yao)師的(de)(de)(de)(de)需(xu)(xu)求也從單一傳(chuan)統的(de)(de)(de)(de)調(diao)劑角色(se)轉變成需(xu)(xu)要履行不同(tong)職責的(de)(de)(de)(de)多種(zhong)角色(se)。可(ke)以從多方面加強藥(yao)師隊伍的(de)(de)(de)(de)建設(she),如建立以臨床需(xu)(xu)求為導向的(de)(de)(de)(de)培(pei)訓(xun)(xun)項目(mu),加大(da)培(pei)訓(xun)(xun)力度,豐(feng)富培(pei)訓(xun)(xun)內(nei)容,制定具有針對(dui)性的(de)(de)(de)(de)人(ren)才(cai)培(pei)養計劃,合理設(she)置藥(yao)學人(ren)員服務收費(fei)項目(mu),提高藥(yao)師工作積(ji)極(ji)性等(deng)。

3.2處方(fang)加大審核(he)力(li)度,促進臨床(chuang)合理用藥

據統(tong)計,全球因(yin)病(bing)死(si)(si)亡的患者(zhe)中,有1/3死(si)(si)于(yu)不(bu)合理用(yong)(yong)(yong)藥(yao)。在臨床用(yong)(yong)(yong)藥(yao)中,會有許多(duo)原因(yin)產生多(duo)藥(yao)聯合應用(yong)(yong)(yong),若忽視這部分(fen)的用(yong)(yong)(yong)藥(yao)風(feng)(feng)險,嚴重不(bu)良事件發生率將會居高不(bu)下。對醫囑進行(xing)用(yong)(yong)(yong)藥(yao)審核,可以提前(qian)發現錯誤,識(shi)別風(feng)(feng)險,對患者(zhe)的用(yong)(yong)(yong)藥(yao)安全非(fei)常重要[6]。通過(guo)文獻查閱及(ji)實(shi)踐工(gong)作(zuo)可得知(zhi),以下措(cuo)施可有助于(yu)審方工(gong)作(zuo)的有效開展。(1)提供循證證據,助力臨床決策;系統(tong)嵌入相(xiang)關(guan)疾病(bing)指南(nan)、專家共識(shi)、說明書并標(biao)明證據等(deng)(deng)級等(deng)(deng)。(2)完(wan)善(shan)(shan)系統(tong)功能,實(shi)現對患者(zhe)、疾病(bing)和藥(yao)品(pin)的自動分(fen)級,可初篩出危重患者(zhe)及(ji)需重點關(guan)注藥(yao)品(pin)品(pin)種(zhong)等(deng)(deng),并進一步完(wan)善(shan)(shan)藥(yao)品(pin)、疾病(bing)病(bing)種(zhong)等(deng)(deng)相(xiang)關(guan)信息,通過(guo)決策樹等(deng)(deng)方式(shi)選擇最適宜(yi)藥(yao)物(wu)和適宜(yi)療(liao)程(cheng),以防(fang)止過(guo)度治(zhi)療(liao)或治(zhi)療(liao)不(bu)足。(3)藥(yao)物(wu)種(zhong)類(lei)提示,對國家基本藥(yao)物(wu)、醫保(bao)推薦進行(xing)自動匯總并警示是否(fou)開具(ju)超標(biao)等(deng)(deng)。

3.3把握(wo)安全(quan)用藥主線,確保(bao)精準高效(xiao)的藥品調劑

智能(neng)化的(de)設備已越來越多地(di)應(ying)用到(dao)醫院(yuan)藥學的(de)實際(ji)工作中,用機器代替人工完成機械性重復操作,能(neng)提(ti)高(gao)工作效(xiao)率,降低人力成本。同(tong)時,智能(neng)化的(de)設備在(zai)減少差錯(cuo)、提(ti)高(gao)運行安全性方面(mian)也能(neng)發揮重要(yao)作用,如藥品全程溯源,個性化報告、效(xiao)期批號管理等,可最大限度減少人員在(zai)藥品日常(chang)管理中的(de)時間消耗[7],使(shi)藥師有更多時間關(guan)注(zhu)審方,提(ti)高(gao)患(huan)者用藥合(he)理性。

3.4致力(li)于(yu)用藥教育和藥學科普,不(bu)斷擴大服務受眾群體

現(xian)階段(duan)藥(yao)師(shi)在臨床治療(liao)過程(cheng)參與(yu)感較弱,其專(zhuan)業(ye)價值(zhi)無法體(ti)(ti)現(xian)。藥(yao)師(shi)可(ke)以用(yong)藥(yao)教育和藥(yao)學科(ke)普(pu)(pu)為抓(zhua)手(shou)點,服務患(huan)者(zhe),從不同(tong)程(cheng)度體(ti)(ti)現(xian)出藥(yao)師(shi)的(de)專(zhuan)業(ye)價值(zhi);可(ke)以增加與(yu)醫護(hu)患(huan)間的(de)相(xiang)互關系(xi),走近患(huan)者(zhe),面向(xiang)大(da)眾,與(yu)醫護(hu)同(tong)行(xing);做好藥(yao)學科(ke)普(pu)(pu),減少藥(yao)物濫用(yong),改變患(huan)者(zhe)就(jiu)醫習慣,讓患(huan)者(zhe)自身有(you)意識且有(you)能(neng)力進行(xing)自我健(jian)(jian)康管理,對日常用(yong)藥(yao)和健(jian)(jian)康管理產(chan)生正(zheng)向(xiang)引導作用(yong),減少醫療(liao)機構不必要的(de)負擔。

4本院全程化藥學服務轉型體系構建工作的探索及實踐

本院(yuan)借鑒全(quan)國(guo)住(zhu)院(yuan)醫師規范化(hua)培(pei)訓(xun)模(mo)式開展(zhan)的(de)成功經驗,結合(he)以上對轉型(xing)方向的(de)思考,在(zai)國(guo)內率先開展(zhan)了藥(yao)(yao)師規范化(hua)培(pei)訓(xun)的(de)工作(zuo)模(mo)式,并在(zai)此基(ji)礎上進一步拓(tuo)展(zhan)藥(yao)(yao)學服務,最終初步形成本院(yuan)全(quan)程化(hua)的(de)藥(yao)(yao)學服務轉型(xing)的(de)體(ti)系架構,具體(ti)詳情(qing)見圖1。

4.1注(zhu)重藥師培訓(xun)

由于(yu)(yu)(yu)(yu)(yu)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)工(gong)(gong)(gong)(gong)作(zuo)的(de)(de)(de)(de)(de)(de)復(fu)雜性,藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)不(bu)僅(jin)需(xu)(xu)要在(zai)校(xiao)期間進(jin)(jin)(jin)行規范(fan)化(hua)(hua)培訓,在(zai)入(ru)職后(hou)更需(xu)(xu)保持常態化(hua)(hua)學(xue)(xue)(xue)(xue)習(xi),只有科(ke)學(xue)(xue)(xue)(xue)設(she)置藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)崗位,合(he)(he)(he)(he)(he)(he)理(li)(li)劃(hua)(hua)分(fen)(fen)人(ren)(ren)員(yuan)(yuan)(yuan)配(pei)置,才(cai)能(neng)(neng)促進(jin)(jin)(jin)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)專業(ye)(ye)化(hua)(hua),做(zuo)好學(xue)(xue)(xue)(xue)科(ke)發(fa)(fa)展規劃(hua)(hua)[8]。4.1.1調劑(ji)(ji)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)為(wei)(wei)(wei)(wei)了(le)(le)(le)促進(jin)(jin)(jin)本院(yuan)(yuan)(yuan)(yuan)(yuan)調劑(ji)(ji)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)自身(shen)專業(ye)(ye)發(fa)(fa)展,實(shi)(shi)(shi)現(xian)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)職業(ye)(ye)轉型,本院(yuan)(yuan)(yuan)(yuan)(yuan)鼓勵門(men)診(zhen)及住院(yuan)(yuan)(yuan)(yuan)(yuan)調劑(ji)(ji)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)多(duo)次(ci)參加(jia)多(duo)項國(guo)(guo)(guo)家級藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)技能(neng)(neng)大賽、模(mo)擬醫(yi)(yi)患(huan)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)情(qing)景(jing)劇等(deng)多(duo)種(zhong)形(xing)式(shi),在(zai)參賽中(zhong)(zhong)(zhong)發(fa)(fa)現(xian)自身(shen)不(bu)足,找到本院(yuan)(yuan)(yuan)(yuan)(yuan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)與(yu)(yu)全(quan)(quan)國(guo)(guo)(guo)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)間的(de)(de)(de)(de)(de)(de)差距,提升自身(shen)知(zhi)(zhi)識水平,提高(gao)(gao)(gao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)服(fu)(fu)(fu)務(wu)人(ren)(ren)文能(neng)(neng)力。4.1.2臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)為(wei)(wei)(wei)(wei)拓寬(kuan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)專業(ye)(ye)及科(ke)學(xue)(xue)(xue)(xue)思(si)(si)(si)(si)維(wei)(wei)(wei),本院(yuan)(yuan)(yuan)(yuan)(yuan)注重藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)技術人(ren)(ren)員(yuan)(yuan)(yuan)進(jin)(jin)(jin)修(xiu)培訓,累(lei)計(ji)送(song)出(chu)(chu)40余(yu)名藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)到全(quan)(quan)國(guo)(guo)(guo)各地臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)培訓基(ji)地進(jin)(jin)(jin)行學(xue)(xue)(xue)(xue)習(xi)深造(zao)。為(wei)(wei)(wei)(wei)了(le)(le)(le)進(jin)(jin)(jin)一步(bu)緊密聯(lian)系(xi)(xi)(xi)(xi)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang),不(bu)與(yu)(yu)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)產生“知(zhi)(zhi)識代溝”。本院(yuan)(yuan)(yuan)(yuan)(yuan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)每年開展“醫(yi)(yi)護(hu)(hu)講(jiang)堂”系(xi)(xi)(xi)(xi)列教學(xue)(xue)(xue)(xue)活動,分(fen)(fen)專業(ye)(ye)組(zu)邀請臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)科(ke)室資深醫(yi)(yi)師(shi)(shi)(shi)(shi)(shi)(shi)、護(hu)(hu)師(shi)(shi)(shi)(shi)(shi)(shi)講(jiang)解臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)典型病(bing)例、專科(ke)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)等(deng)知(zhi)(zhi)識,使藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)深入(ru)學(xue)(xue)(xue)(xue)習(xi)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)專業(ye)(ye)知(zhi)(zhi)識,積累(lei)經驗,交流(liu)審(shen)方(fang)(fang)(fang)過(guo)程中(zhong)(zhong)(zhong)發(fa)(fa)現(xian)的(de)(de)(de)(de)(de)(de)問(wen)題,為(wei)(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)與(yu)(yu)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)醫(yi)(yi)護(hu)(hu)人(ren)(ren)員(yuan)(yuan)(yuan)搭建(jian)溝通(tong)平臺。4.1.3審(shen)方(fang)(fang)(fang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)隨(sui)著對(dui)(dui)(dui)處方(fang)(fang)(fang)審(shen)方(fang)(fang)(fang)的(de)(de)(de)(de)(de)(de)要求日益(yi)嚴(yan)格,審(shen)方(fang)(fang)(fang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)由此(ci)衍(yan)生,其(qi)主要是通(tong)過(guo)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)資料,對(dui)(dui)(dui)所有處方(fang)(fang)(fang)進(jin)(jin)(jin)行審(shen)核(he)(he)(he)(he),對(dui)(dui)(dui)錯誤醫(yi)(yi)囑(zhu)進(jin)(jin)(jin)行攔截,做(zuo)到“事前干預”,體現(xian)了(le)(le)(le)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)專業(ye)(ye)價(jia)值,一定(ding)程度上(shang)彌(mi)補了(le)(le)(le)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)數(shu)量不(bu)足的(de)(de)(de)(de)(de)(de)問(wen)題。本院(yuan)(yuan)(yuan)(yuan)(yuan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)每年制(zhi)定(ding)不(bu)同(tong)審(shen)方(fang)(fang)(fang)重點(dian)工(gong)(gong)(gong)(gong)作(zuo)計(ji)劃(hua)(hua),按照既(ji)定(ding)目(mu)標推進(jin)(jin)(jin)全(quan)(quan)醫(yi)(yi)囑(zhu)審(shen)核(he)(he)(he)(he)工(gong)(gong)(gong)(gong)作(zuo),促進(jin)(jin)(jin)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)醫(yi)(yi)囑(zhu)規范(fan)化(hua)(hua)。為(wei)(wei)(wei)(wei)了(le)(le)(le)培養審(shen)方(fang)(fang)(fang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)思(si)(si)(si)(si)維(wei)(wei)(wei),使審(shen)核(he)(he)(he)(he)醫(yi)(yi)囑(zhu)達到同(tong)質化(hua)(hua)效(xiao)果,本院(yuan)(yuan)(yuan)(yuan)(yuan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)于(yu)(yu)(yu)(yu)(yu)2020年3月率(lv)(lv)先開展全(quan)(quan)員(yuan)(yuan)(yuan)參與(yu)(yu)處方(fang)(fang)(fang)點(dian)評,判(pan)斷(duan)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)時(shi)在(zai)原有的(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)思(si)(si)(si)(si)維(wei)(wei)(wei)基(ji)礎上(shang)加(jia)入(ru)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)思(si)(si)(si)(si)維(wei)(wei)(wei),從“醫(yi)(yi)師(shi)(shi)(shi)(shi)(shi)(shi)為(wei)(wei)(wei)(wei)何開出(chu)(chu)這(zhe)張(zhang)處方(fang)(fang)(fang)”的(de)(de)(de)(de)(de)(de)角度多(duo)點(dian)考慮,而不(bu)是僅(jin)僅(jin)把不(bu)合(he)(he)(he)(he)(he)(he)理(li)(li)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)(de)(de)(de)矛頭(tou)對(dui)(dui)(dui)準(zhun)醫(yi)(yi)師(shi)(shi)(shi)(shi)(shi)(shi),提升自身(shen)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)專業(ye)(ye)水平,使其(qi)在(zai)平時(shi)工(gong)(gong)(gong)(gong)作(zuo)中(zhong)(zhong)(zhong)勤(qin)練內功,扎實(shi)(shi)(shi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)功底(di)。4.1.4科(ke)研藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)借(jie)助“源于(yu)(yu)(yu)(yu)(yu)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)-證(zheng)于(yu)(yu)(yu)(yu)(yu)試(shi)驗-歸于(yu)(yu)(yu)(yu)(yu)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)”的(de)(de)(de)(de)(de)(de)科(ke)研發(fa)(fa)展思(si)(si)(si)(si)路(lu),讓藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)在(zai)工(gong)(gong)(gong)(gong)作(zuo)時(shi)間中(zhong)(zhong)(zhong)培養出(chu)(chu)良好的(de)(de)(de)(de)(de)(de)科(ke)研思(si)(si)(si)(si)路(lu),根(gen)據(ju)需(xu)(xu)求驅(qu)動、服(fu)(fu)(fu)務(wu)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang),在(zai)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)治療(liao)匯(hui)總、凝(ning)練科(ke)學(xue)(xue)(xue)(xue)問(wen)題,尤(you)其(qi)是基(ji)于(yu)(yu)(yu)(yu)(yu)本省特色進(jin)(jin)(jin)行科(ke)研,有助于(yu)(yu)(yu)(yu)(yu)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)團隊(dui)的(de)(de)(de)(de)(de)(de)自身(shen)發(fa)(fa)展。4.1.5家庭(ting)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)隨(sui)著我國(guo)(guo)(guo)進(jin)(jin)(jin)入(ru)老齡化(hua)(hua)社(she)會,空巢老人(ren)(ren)比例不(bu)斷(duan)上(shang)升,慢性疾病(bing)中(zhong)(zhong)(zhong)老齡人(ren)(ren)口的(de)(de)(de)(de)(de)(de)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)問(wen)題已成(cheng)為(wei)(wei)(wei)(wei)重要的(de)(de)(de)(de)(de)(de)健康隱患(huan),建(jian)立家庭(ting)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)制(zhi)度逐漸成(cheng)為(wei)(wei)(wei)(wei)慢性疾病(bing)管理(li)(li)的(de)(de)(de)(de)(de)(de)剛性需(xu)(xu)求。本院(yuan)(yuan)(yuan)(yuan)(yuan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)基(ji)于(yu)(yu)(yu)(yu)(yu)此(ci)國(guo)(guo)(guo)情(qing),在(zai)前期用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)宣教過(guo)程中(zhong)(zhong)(zhong),與(yu)(yu)有上(shang)門(men)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)服(fu)(fu)(fu)務(wu)需(xu)(xu)求的(de)(de)(de)(de)(de)(de)居民(min)交流(liu)并留存其(qi)聯(lian)系(xi)(xi)(xi)(xi)方(fang)(fang)(fang)式(shi),為(wei)(wei)(wei)(wei)日后(hou)本院(yuan)(yuan)(yuan)(yuan)(yuan)開展家庭(ting)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)服(fu)(fu)(fu)務(wu)打好基(ji)礎。4.1.6信(xin)息(xi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)隨(sui)著互聯(lian)網在(zai)醫(yi)(yi)療(liao)中(zhong)(zhong)(zhong)參與(yu)(yu)度越(yue)來越(yue)高(gao)(gao)(gao),臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)工(gong)(gong)(gong)(gong)作(zuo)對(dui)(dui)(dui)“通(tong)專業(ye)(ye)+懂技術”的(de)(de)(de)(de)(de)(de)人(ren)(ren)才(cai)需(xu)(xu)求越(yue)來越(yue)迫切,信(xin)息(xi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)出(chu)(chu)現(xian)彌(mi)補了(le)(le)(le)此(ci)類需(xu)(xu)求,其(qi)主要致(zhi)力于(yu)(yu)(yu)(yu)(yu)優(you)化(hua)(hua)治療(liao)方(fang)(fang)(fang)案,對(dui)(dui)(dui)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物審(shen)方(fang)(fang)(fang)設(she)定(ding)規則,維(wei)(wei)(wei)護(hu)(hu)合(he)(he)(he)(he)(he)(he)理(li)(li)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)系(xi)(xi)(xi)(xi)統(tong)(tong)(tong),以快速、分(fen)(fen)析、整(zheng)合(he)(he)(he)(he)(he)(he)信(xin)息(xi)的(de)(de)(de)(de)(de)(de)獨有優(you)勢(shi)(shi)將藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)情(qing)報(bao)和信(xin)息(xi)系(xi)(xi)(xi)(xi)統(tong)(tong)(tong)連接起來,成(cheng)為(wei)(wei)(wei)(wei)有藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)背景(jing)的(de)(de)(de)(de)(de)(de)“信(xin)息(xi)工(gong)(gong)(gong)(gong)程師(shi)(shi)(shi)(shi)(shi)(shi)”。2020年4月起,本院(yuan)(yuan)(yuan)(yuan)(yuan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)部(bu)安(an)排部(bu)分(fen)(fen)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)對(dui)(dui)(dui)合(he)(he)(he)(he)(he)(he)理(li)(li)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)監測系(xi)(xi)(xi)(xi)統(tong)(tong)(tong)(PASS)和靜脈用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)調配(pei)中(zhong)(zhong)(zhong)心(PIVAS)系(xi)(xi)(xi)(xi)統(tong)(tong)(tong)中(zhong)(zhong)(zhong)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)部(bu)分(fen)(fen)系(xi)(xi)(xi)(xi)統(tong)(tong)(tong)進(jin)(jin)(jin)行初步(bu)維(wei)(wei)(wei)護(hu)(hu),建(jian)立“藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)+智慧軟(ruan)(ruan)件(jian)”工(gong)(gong)(gong)(gong)作(zuo)模(mo)式(shi),為(wei)(wei)(wei)(wei)全(quan)(quan)醫(yi)(yi)囑(zhu)審(shen)核(he)(he)(he)(he)助力。本院(yuan)(yuan)(yuan)(yuan)(yuan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)部(bu)在(zai)全(quan)(quan)國(guo)(guo)(guo)率(lv)(lv)先探索(suo)實(shi)(shi)(shi)施(shi)了(le)(le)(le)“藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)+智慧軟(ruan)(ruan)件(jian)”的(de)(de)(de)(de)(de)(de)全(quan)(quan)醫(yi)(yi)囑(zhu)規范(fan)化(hua)(hua)審(shen)核(he)(he)(he)(he)模(mo)式(shi)[9-10],做(zuo)到充分(fen)(fen)掌(zhang)握患(huan)者病(bing)情(qing),使所有住院(yuan)(yuan)(yuan)(yuan)(yuan)患(huan)者享(xiang)受(shou)同(tong)質化(hua)(hua)的(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)服(fu)(fu)(fu)務(wu)。合(he)(he)(he)(he)(he)(he)理(li)(li)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)系(xi)(xi)(xi)(xi)統(tong)(tong)(tong)通(tong)過(guo)計(ji)算機(ji)編程技術與(yu)(yu)PASS形(xing)成(cheng)對(dui)(dui)(dui)接,形(xing)成(cheng)雙重審(shen)核(he)(he)(he)(he)機(ji)制(zhi),對(dui)(dui)(dui)不(bu)合(he)(he)(he)(he)(he)(he)理(li)(li)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)醫(yi)(yi)囑(zhu)予以攔截,實(shi)(shi)(shi)現(xian)全(quan)(quan)醫(yi)(yi)囑(zhu)審(shen)核(he)(he)(he)(he)。通(tong)過(guo)全(quan)(quan)面整(zheng)合(he)(he)(he)(he)(he)(he)醫(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)多(duo)系(xi)(xi)(xi)(xi)統(tong)(tong)(tong)數(shu)據(ju),使藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)(shi)(shi)能(neng)(neng)夠及時(shi)查(cha)閱患(huan)者在(zai)院(yuan)(yuan)(yuan)(yuan)(yuan)相關信(xin)息(xi),準(zhun)確(que)掌(zhang)握患(huan)者病(bing)情(qing)。以“大數(shu)據(ju)理(li)(li)念”為(wei)(wei)(wei)(wei)核(he)(he)(he)(he)心思(si)(si)(si)(si)想(xiang),本院(yuan)(yuan)(yuan)(yuan)(yuan)結合(he)(he)(he)(he)(he)(he)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)(chuang)診(zhen)療(liao)工(gong)(gong)(gong)(gong)作(zuo)特點(dian),對(dui)(dui)(dui)合(he)(he)(he)(he)(he)(he)理(li)(li)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)系(xi)(xi)(xi)(xi)統(tong)(tong)(tong)進(jin)(jin)(jin)行二次(ci)開發(fa)(fa),使合(he)(he)(he)(he)(he)(he)理(li)(li)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)系(xi)(xi)(xi)(xi)統(tong)(tong)(tong)與(yu)(yu)醫(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)信(xin)息(xi)系(xi)(xi)(xi)(xi)統(tong)(tong)(tong)數(shu)據(ju)形(xing)成(cheng)無縫交互,實(shi)(shi)(shi)現(xian)全(quan)(quan)流(liu)程數(shu)字(zi)化(hua)(hua)和二維(wei)(wei)(wei)碼管控,充分(fen)(fen)發(fa)(fa)揮信(xin)息(xi)系(xi)(xi)(xi)(xi)統(tong)(tong)(tong)精確(que)、高(gao)(gao)(gao)效(xiao)的(de)(de)(de)(de)(de)(de)優(you)勢(shi)(shi),在(zai)提高(gao)(gao)(gao)工(gong)(gong)(gong)(gong)作(zuo)效(xiao)率(lv)(lv)的(de)(de)(de)(de)(de)(de)同(tong)時(shi)將差錯率(lv)(lv)降到最低。

4.2確(que)保精準高(gao)效(xiao)的藥品調配(pei)

隨著人們健康水平和健康意識的(de)提(ti)高(gao),本院門(men)診就診量和藥品需求量逐年增加,患(huan)者取藥排(pai)隊和等候(hou)時間隨之(zhi)延長,導致門(men)診大廳環境嘈雜擁擠。為(wei)此,本院在(zai)2017年3月引進門(men)診智能發藥系統,創(chuang)建了青海省首(shou)家現代化(hua)智能藥房。為(wei)實現住院患(huan)者口服藥品單劑(ji)量頓服,提(ti)升藥學(xue)服務質量,促進藥房擺藥自(zi)動(dong)(dong)化(hua),本院在(zai)2017年引入全自(zi)動(dong)(dong)擺藥機(ji)(ji),該機(ji)(ji)器可自(zi)動(dong)(dong)切半(ban)片,減少(shao)人為(wei)擺藥差錯,提(ti)高(gao)調劑(ji)效率,提(ti)高(gao)患(huan)者依從性。

4.3以用藥教育和藥學科普(pu)擴大受眾群體

青海(hai)省(sheng)地處(chu)青藏(zang)高(gao)原(yuan),居民(min)(min)(min)組成(cheng)和(he)(he)文(wen)(wen)化(hua)(hua)素養差別(bie)較(jiao)大(da),存在(zai)(zai)(zai)(zai)多(duo)(duo)民(min)(min)(min)族聚集和(he)(he)居民(min)(min)(min)健康素養不足(zu)的(de)(de)(de)(de)(de)特點(dian),語(yu)(yu)言(yan)涉及(ji)(ji)(ji)(ji)(ji)各種(zhong)(zhong)少數民(min)(min)(min)族方(fang)(fang)言(yan),語(yu)(yu)言(yan)體(ti)系繁(fan)多(duo)(duo),少數民(min)(min)(min)族占全(quan)省(sheng)人(ren)(ren)口總數的(de)(de)(de)(de)(de)46.98%,經(jing)濟水平落后,文(wen)(wen)盲率高(gao)達12.94%,對(dui)(dui)(dui)少數民(min)(min)(min)族開展用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)宣(xuan)(xuan)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)是青海(hai)省(sheng)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)宣(xuan)(xuan)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)的(de)(de)(de)(de)(de)重點(dian)。在(zai)(zai)(zai)(zai)對(dui)(dui)(dui)青海(hai)省(sheng)患(huan)者(zhe)(zhe)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)育(yu)時發現,患(huan)者(zhe)(zhe)因(yin)多(duo)(duo)種(zhong)(zhong)原(yuan)因(yin)導致用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)育(yu)效果不夠理想。(1)有(you)效傳(chuan)播(bo)媒介(jie)欠缺:部分患(huan)者(zhe)(zhe)因(yin)文(wen)(wen)化(hua)(hua)程(cheng)度(du)(du)不高(gao),用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)劑量不適宜甚至用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)錯誤(wu)的(de)(de)(de)(de)(de)狀況時常(chang)發生(sheng),如(ru)以(yi)(yi)(yi)常(chang)規(gui)圖文(wen)(wen)并茂的(de)(de)(de)(de)(de)形(xing)式(shi)進行用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)宣(xuan)(xuan)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao),宣(xuan)(xuan)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)效果可(ke)能不盡(jin)如(ru)人(ren)(ren)意。(2)傳(chuan)播(bo)對(dui)(dui)(dui)象依從性(xing)欠缺:用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)育(yu)及(ji)(ji)(ji)(ji)(ji)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)經(jing)常(chang)出(chu)(chu)現語(yu)(yu)言(yan)不通,醫患(huan)溝通困難,涉及(ji)(ji)(ji)(ji)(ji)需有(you)特殊(shu)(shu)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)法(fa)(fa)的(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物時,患(huan)者(zhe)(zhe)對(dui)(dui)(dui)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)依從性(xing)等(deng)(deng)方(fang)(fang)面(mian)(mian)存在(zai)(zai)(zai)(zai)偏差,藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)使(shi)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)風險升高(gao)。(3)符合(he)青海(hai)省(sheng)疾病譜(pu)的(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)育(yu)及(ji)(ji)(ji)(ji)(ji)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)資料欠缺:基層藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)服(fu)務(wu)人(ren)(ren)員(yuan)極度(du)(du)匱乏(fa),在(zai)(zai)(zai)(zai)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)宣(xuan)(xuan)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)方(fang)(fang)面(mian)(mian)宣(xuan)(xuan)傳(chuan)力度(du)(du)不到位,尤(you)其符合(he)青海(hai)省(sheng)疾病譜(pu)的(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)育(yu)及(ji)(ji)(ji)(ji)(ji)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)工(gong)(gong)作(zuo)(zuo)更(geng)為(wei)欠缺。針對(dui)(dui)(dui)以(yi)(yi)(yi)上特點(dian),本(ben)院(yuan)(yuan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)以(yi)(yi)(yi)患(huan)者(zhe)(zhe)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)育(yu)工(gong)(gong)作(zuo)(zuo)為(wei)契(qi)機,逐步(bu)積累經(jing)驗(yan),根據本(ben)省(sheng)疾病譜(pu)創(chuang)作(zuo)(zuo)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)作(zuo)(zuo)品(pin)(pin),通過(guo)“線上+線下”的(de)(de)(de)(de)(de)模(mo)式(shi)進行患(huan)者(zhe)(zhe)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)育(yu),定期輸出(chu)(chu)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)作(zuo)(zuo)品(pin)(pin)。“線上模(mo)式(shi)”主(zhu)要(yao)是收集日常(chang)工(gong)(gong)作(zuo)(zuo)中患(huan)者(zhe)(zhe)關切的(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)內(nei)容,以(yi)(yi)(yi)簡單的(de)(de)(de)(de)(de)語(yu)(yu)言(yan)、微信(xin)、音頻(pin)(pin)、視(shi)(shi)頻(pin)(pin)為(wei)載體(ti),通過(guo)多(duo)(duo)種(zhong)(zhong)形(xing)式(shi)解(jie)決(jue)患(huan)者(zhe)(zhe)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)難題(ti)。如(ru)建立微信(xin)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)育(yu)公眾(zhong)平臺,在(zai)(zai)(zai)(zai)線上開展公眾(zhong)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)育(yu),普(pu)(pu)(pu)(pu)(pu)(pu)及(ji)(ji)(ji)(ji)(ji)和(he)(he)宣(xuan)(xuan)傳(chuan)安全(quan)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)(de)(de)知(zhi)識,使(shi)廣大(da)患(huan)者(zhe)(zhe)能夠正確地使(shi)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin),自(zi)覺地參(can)(can)與和(he)(he)關注用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安全(quan)問題(ti)。針對(dui)(dui)(dui)青海(hai)省(sheng)多(duo)(duo)民(min)(min)(min)族特點(dian)的(de)(de)(de)(de)(de)現狀,本(ben)院(yuan)(yuan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)拍(pai)攝制作(zuo)(zuo)了(le)(le)多(duo)(duo)民(min)(min)(min)族語(yu)(yu)言(yan)版(ban)本(ben)的(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)視(shi)(shi)頻(pin)(pin),包括漢語(yu)(yu)版(ban)、藏(zang)語(yu)(yu)版(ban)及(ji)(ji)(ji)(ji)(ji)蒙語(yu)(yu)版(ban)等(deng)(deng),供(gong)臨床患(huan)者(zhe)(zhe)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)習使(shi)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)。視(shi)(shi)頻(pin)(pin)中涉及(ji)(ji)(ji)(ji)(ji)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物均為(wei)青海(hai)省(sheng)常(chang)見疾病的(de)(de)(de)(de)(de)常(chang)見藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)使(shi)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)方(fang)(fang)法(fa)(fa),該方(fang)(fang)法(fa)(fa)較(jiao)大(da)程(cheng)度(du)(du)上可(ke)以(yi)(yi)(yi)解(jie)決(jue)患(huan)者(zhe)(zhe)因(yin)不識字(zi)或者(zhe)(zhe)語(yu)(yu)言(yan)不通的(de)(de)(de)(de)(de)問題(ti)。為(wei)進一步(bu)擴(kuo)(kuo)展高(gao)原(yuan)患(huan)者(zhe)(zhe)的(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)工(gong)(gong)作(zuo)(zuo)成(cheng)果,本(ben)院(yuan)(yuan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)立足(zu)工(gong)(gong)作(zuo)(zuo)實際,積極參(can)(can)加國(guo)內(nei)各項藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)比(bi)賽并均取得較(jiao)好成(cheng)績,作(zuo)(zuo)品(pin)(pin)多(duo)(duo)以(yi)(yi)(yi)本(ben)省(sheng)疾病特點(dian)為(wei)主(zhu),以(yi)(yi)(yi)改(gai)編(bian)歌曲、情景劇創(chuang)作(zuo)(zuo)等(deng)(deng)方(fang)(fang)式(shi)普(pu)(pu)(pu)(pu)(pu)(pu)及(ji)(ji)(ji)(ji)(ji)公眾(zhong)安全(quan)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)知(zhi)識,促進青海(hai)省(sheng)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)多(duo)(duo)元化(hua)(hua)發展。“線下模(mo)式(shi)”主(zhu)要(yao)聯(lian)合(he)基層藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)開展科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)活動。本(ben)院(yuan)(yuan)將(jiang)西(xi)寧頤(yi)和(he)(he)老年樂園(yuan)和(he)(he)青海(hai)省(sheng)特殊(shu)(shu)教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)育(yu)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)校納(na)為(wei)長期藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)服(fu)務(wu)對(dui)(dui)(dui)象,固定時間開展藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)。并定期對(dui)(dui)(dui)轄區(qu)內(nei)8個辦事處(chu)居民(min)(min)(min)進行日常(chang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu),解(jie)答(da)居民(min)(min)(min)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)疑(yi)問。為(wei)了(le)(le)擴(kuo)(kuo)大(da)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)服(fu)務(wu)的(de)(de)(de)(de)(de)輻射面(mian)(mian),進一步(bu)調動基層藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)積極性(xing),本(ben)院(yuan)(yuan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)將(jiang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)工(gong)(gong)作(zuo)(zuo)帶(dai)到了(le)(le)離(li)西(xi)寧有(you)800公里外(wai)(wai)的(de)(de)(de)(de)(de)玉樹(shu)(shu)地區(qu)。本(ben)院(yuan)(yuan)在(zai)(zai)(zai)(zai)玉樹(shu)(shu)、果洛、瑪多(duo)(duo)等(deng)(deng)地區(qu)設有(you)一對(dui)(dui)(dui)一幫扶合(he)作(zuo)(zuo)醫院(yuan)(yuan),幫扶藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)可(ke)涉及(ji)(ji)(ji)(ji)(ji)全(quan)省(sheng)多(duo)(duo)個牧區(qu)醫院(yuan)(yuan),以(yi)(yi)(yi)點(dian)帶(dai)面(mian)(mian),全(quan)方(fang)(fang)位開展藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)工(gong)(gong)作(zuo)(zuo)。除了(le)(le)參(can)(can)與本(ben)省(sheng)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)工(gong)(gong)作(zuo)(zuo)外(wai)(wai),本(ben)院(yuan)(yuan)還(huan)積極與全(quan)國(guo)優秀的(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)同道(dao)共同奮斗(dou),助(zhu)力藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)傳(chuan)播(bo)。例如(ru)參(can)(can)編(bian)由(you)(you)中華醫學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)會臨床藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)分會牽頭(tou)編(bian)撰的(de)(de)(de)(de)(de)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)叢(cong)書,參(can)(can)與由(you)(you)國(guo)家衛生(sheng)健康委員(yuan)會能力建設和(he)(he)繼續教(jiao)(jiao)(jiao)(jiao)(jiao)(jiao)育(yu)中心主(zhu)辦的(de)(de)(de)(de)(de)家庭(ting)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)規(gui)范化(hua)(hua)培訓等(deng)(deng),分別(bie)以(yi)(yi)(yi)出(chu)(chu)版(ban)物和(he)(he)網絡授課形(xing)式(shi),多(duo)(duo)角度(du)(du)、多(duo)(duo)方(fang)(fang)位開展藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)(xue)(xue)(xue)(xue)(xue)(xue)(xue)科(ke)(ke)(ke)(ke)(ke)普(pu)(pu)(pu)(pu)(pu)(pu)工(gong)(gong)作(zuo)(zuo)。

5小結

通過(guo)藥(yao)學(xue)服(fu)務轉型的不(bu)斷(duan)實(shi)踐和改進,本院藥(yao)師在藥(yao)師的梯隊建設(she)、信息化助力藥(yao)學(xue)審方(fang)、致(zhi)力科普擴大受眾面等(deng)多(duo)方(fang)面均有較大提升,已經(jing)初步達成了“一切以(yi)患(huan)(huan)者(zhe)為(wei)中(zhong)(zhong)心(xin)”的基本共識。但是(shi)在此探索過(guo)程中(zhong)(zhong),仍有多(duo)方(fang)面需要改進的地方(fang),例(li)如本院藥(yao)師接(jie)觸臨床(chuang)機(ji)會(hui)有限,對臨床(chuang)知識缺乏深度(du)理解,關于臨床(chuang)提出(chu)的藥(yao)學(xue)問(wen)題(ti)不(bu)能形成“即時反饋”;系統模塊(kuai)開發(fa)暫未達到(dao)預期的分級效果,藥(yao)師審方(fang)過(guo)程中(zhong)(zhong)無法對患(huan)(huan)者(zhe)輕重緩急進行精(jing)準(zhun)判斷(duan),審方(fang)的深度(du)、廣度(du)不(bu)足等(deng)。隨著全國藥(yao)學(xue)服(fu)務的全速(su)發(fa)展,希望通過(guo)該方(fang)式(shi)能夠(gou)與(yu)省外醫療機(ji)構交(jiao)流學(xue)習,不(bu)斷(duan)完善本院藥(yao)學(xue)服(fu)務轉型體系,進一步為(wei)患(huan)(huan)者(zhe)提供高質量藥(yao)學(xue)服(fu)務。

作者：辛雅雯(wen) 王(wang)亞(ya)峰 單位：青海省(sheng)人民醫院(yuan)