【作者】 朱立勤；

【导师】 高文远；

【作者基本信息】 天津大学 ， 药事管理， 2011， 博士

【摘要】 随着社会、经济和科技的发展,医疗逐渐成为人们日益关心的问题,而医疗中的药品安全使用问题也相应成为医疗中最受关注的一个方面。保证临床安全、合理用药是一项至关重要的工作。临床药师作为一种在国内刚刚开展起来的职业,逐渐成为临床治疗团队中的主要成员之一,尤其在临床用药安全性评价和控制中承担着重要的角色。本文从临床药师的角度探讨了临床用药安全性评价和控制,分析和确立了临床药师在临床用药安全性管理中的主体作用,提出了在用药前、用药过程中、用药后的整个用药过程实施全程化评价控制的观念,并在各环节中分别运用多种模型和药师监护实例进行安全性分析和评价控制,提高临床用药安全性。在对临床用药安全性实施主体分析中,以调查问卷的形式分析了中国北方地区医护人员及患者对临床药师的认知度,并对其基本状况、工作模式等进行了详细的探讨,充分认识到临床药师在临床安全性评价中的主体地位。用药前从药品质量和调剂过程两个方面进行安全性评价控制。在对药品质量的控制中运用PDCA循环法分析了药品质量缺陷的原因,并制定和实施了相应对策,保证了医院药品质量安全。在用药前的调剂中,分析了药师调剂的正确流程、现存的调剂不安全因素以及相应的预防和处理措施。用药过程中对患者的药学评价和监护中,本文提出药师对患者的监护点,并以临床药师针对不同监护点进行监护并取得良好效果的病例为实例,详细分析了药师对患者实施监护控制对安全性的作用。在用药后对临床用药安全性问题进行分析、评价和干预控制中,对目前临床用药安全性现状进行了分析,提出了药师用不同模型评价用药安全性的方法,并以中药注射剂及抗菌药物注射剂的安全性为例,分别运用因素分析法、层次分析法、决策树法等不同方法对其影响因素进行了评价。以荟萃分析法评价了药物对肾脏的安全性。本文还对常见的临床用药不安全因素进行了有针对性的临床干预,取得良好效果。更多还原

【Abstract】 As the development of society, economy and technology, the medical treatment had increasingly become an interesting problem. The ensurance of safe and rational administration was the most significant work in medical treatment. As a new occupation, the clinical pharmacists had gradually become one of the team members in clinical treatment group, expecially played significant roles in appreciation and control about administration safety in clinic.In this paper, the problem of appreciation and control about administration safety in clinic had been researched from the view of clinical pharmacists. The main role of clinical pharmacists in safe administration of drug in clinic had been established. The concept of appreciation and control within the whole range (before, after and at the course) of administration had been proposed. And a series of models and examples under the surveille by clinical pharmacists had been used in analysis and appreciation to improve the administration safety.In the analysis to the safety of clinical medication, the cognition to clinical pharmacists in the northern part of China was investigated in the way of questionairs. The basic situation and mode of service of clinical pharmacists were detailedly researched. The main role of clinical pharmacists in appreciation and control to administration safety in clinic was sufficiently realized. The appreciation and control before administration lied in drug quality and drug dispensing. The PDCA circulation method was used to study the cause of vicious quality of drug in hospital, and a series of measures were practised to aim directly at administration safety in order to ensure the safety of drug quality before administration. The flowsheet, unsafe factors, and direct measures in prevention and disposal were analyzed in pharmacists dispensing. In the course of administration, the different monitoring points were suggested and the cases, which were monitored successfully by pharmacists, were provided to analyze the safety of drug administration from these monitoring points. At the appreciation and control after administration, the clinical medication state was investigated. Different models which included factor analysis, analytic hierarchy process, and topliss decision approach were proposed to evaluate the influencing factors to the safety focusing on the Chinese herb medicine injections and antibiotics injections. Moreover, the method of meta-analysis was introduced while analyzing the influence of drugs to kidney. The risk factors in clinic were intervened in this paper and got ideal effects.更多还原