What Does a Clinical Pharmacist Do?

Clinical pharmacist is a profession relying on clinical pharmacy, a profession that combines medicine, discusses the clinical application of drugs, and implements rational drug use. It originated in the United States and is a new profession in China.

Chinese name: The clinician

Foreign name: Clinician

Clinical pharmacist profile

The clinical pharmacist, with his rich knowledge of modern pharmacy, works with physicians to provide and design patients with the safest and most reasonable medication regimen. A clinical pharmacist is a person who plays a key role in helping doctors use drugs rationally. He can assist doctors at the right time for Patients prescribe the correct drugs and correct dosages, avoid adverse interactions between drugs, and solve problems related to factors affecting drug treatment. They play an important role in the rational use of drugs. This is for physicians who are difficult to master and use the comprehensive knowledge of modern medicines for rational medication. The emergence of clinical pharmacists will undoubtedly give them a full use of medicines and provide a strong guarantee for the rationality, safety and effectiveness of drug treatment. The place is welcomed by clinicians. In some large medical centers in the United States, there are clinical pharmacy service organizations. One or more doctors must work with a clinical pharmacist. Medical institutions are not allowed without the participation of a clinical pharmacist. Opening.

Clinical pharmacist background

Clinical pharmacy originated in the United States. At the time, due to adverse reactions and drug-induced damage to drugs, many patients, families, and society brought pain and heavy burdens. This society and the needs of patients contributed to the birth and development of clinical pharmacy. From the 1950s to the 1960s, the United States first established the emerging discipline of clinical pharmacy, shifting the focus of traditional pharmaceutical education from "medicine" to "people". In addition to the completion of drug supply and distribution, hospital pharmacy workers also need to go to the clinic to participate in doctors' medication and assist clinical drug selection to improve the efficacy and reduce the incidence of toxic and side effects. Due to the successful practice of the American pharmacy community, many countries have followed suit and started patient-centered pharmacy services to improve the overall pharmacy level of hospitals as an inevitable trend in the development of hospital pharmacy.

As a result, two changes have taken place in the international pharmacy field. On the one hand, doctors who are mainly diagnostics need the help of pharmacists in the selection and use of therapeutic drugs; on the other hand, the increased awareness of patients' self-protection makes them more aware of their use. These have led the focus of pharmacists to clinical pharmacy. The development of clinical pharmacy in developed countries after more than 40 years shows that the participation of clinical pharmacists in the treatment can promote the rational use of medicines, reduce adverse reactions and waste of health resources.

Development status of clinical pharmacists

Western developed countries generally started to set up a clinical pharmacy specialty in the 1960s. China issued a document in 2002 to gradually establish a clinical pharmacist system. Take the pharmaceutical education in the United States as an example. Pharm. D. Professional education courses. In 1967, it was proposed that "clinical pharmacy students" should be in clinical practice. In 1974, it was required that 1500 hours of clinical internships be required. On July 14, 1997, the American Board of Pharmacy Education decided to fully implement Pharm from June 1, 2000 D. Professional education. Other pharmaceutical education will stop after 2005. After nearly 50 years of development, Pharm. D. Professional Education.

In China, in the 1960s, China's drug market system under the planned economy system was still not complete. There was a single variety of medical drugs, backward production facilities for preparations, and lack of professional and technical personnel in pharmacy. The main tasks of hospital pharmacy were to ensure the supply of drugs and meet the clinical use of drugs. demand. Therefore, although some scholars in China proposed clinical pharmacy work as early as 40 years ago, subjective and objective conditions did not exist or allowed clinical pharmacy work until the early 1980s. With the opening of the domestic pharmaceutical market and the Prosperity, the gradual standardization of drug management, the establishment of emerging disciplines such as pharmacokinetics, biopharmaceutics, etc. Only after the hospital's rational use of medicines finally received the attention of the medical community, did the clinical pharmacy work really start and develop.

In the past 20 years, certain achievements have been made in the development of domestic clinical pharmacy:

Clinical pharmacist policy support

In 1987, the Ministry of Health approved 12 key hospitals as national clinical pharmacy pilot units; in 1991, the Ministry of Health for the first time stipulated in the hospital grade management document that clinical medicine work must be carried out in tertiary hospitals, and was used as one of the hospital's assessment indicators. ; In January 2002, the Ministry of Health and the State Administration of Traditional Chinese Medicine promulgated the "Interim Provisions on the Administration of Pharmaceutical Affairs in Medical Institutions", which clearly states that "clinical pharmacy work should be oriented to patients, and medical integration should be implemented in clinical diagnosis and treatment activities. Professional staff of clinical pharmacy Should participate in the design of clinical drug treatment programs, establish key patient medical records, implement therapeutic drug monitoring, and gradually establish a clinical pharmacist system ... ", in November 2005, issued a" Notice on the Pilot Work of Training Clinical Pharmacists "and announced the" Clinical Pharmacist Training Pilot Work Plan "and 4 attachments. In 2006, the "On-the-job Training and Evaluation Standards for Clinical Pharmacists of the Ministry of Health (Trial)" was promulgated. 19 hospitals were designated as training bases for clinical pharmacists throughout the country and a training model was proposed. This work started in 2007 and has gained some experience. In the 190th document of the Ministry of Health in 2007, it was clearly stated that 42 hospitals should be used as pilots to carry out the pilot work of the pharmacist system. In principle, the number of clinical pharmacists should be no less than five in third-level hospitals and no less than three in second-level hospitals.

Clinical pharmacist education

Since the early 1980s, China has successively carried out various forms of clinical pharmacist education. In terms of academic education, the former West China Medical University School of Pharmacy and Dalian Medical College respectively piloted 5-year undergraduate clinical pharmacy majors. Although some work could not be continued, it provided exploratory experience for the curriculum setting of clinical pharmacy and the training of clinical pharmacists. In 1999, the Ministry of Health issued the "Outline of Standardized Training for Hospital Pharmacists" (trial), which stipulated that in the last two years of the five-year training in two phases, clinical knowledge training must be conducted and clinical practice internships, including rounds, consultations, and medical treatement. The curriculum reform project "Research on the Clinical Pharmacy Curriculum System and Content" of the Ministry of Education's curriculum system for the 21st century has completed and formed a clinical pharmacy curriculum group, and the textbook "Essays on Clinical Pharmacy" has also been published. In addition, a number of plans for reforming pharmaceutical education and training clinical pharmacists are in full swing. Shanghai Fudan University School of Pharmacy, Second Military Medical University, and Sichuan University West China Medical Center are preparing to offer postgraduate courses in clinical pharmacy. In terms of continuing education, various training courses for clinical pharmacists and new development courses in clinical pharmacy have sprung up and gradually standardized and institutionalized. They have imparted new knowledge and new skills in clinical pharmacy to a large number of pharmaceutical technicians. Clinical pharmacy has played a positive role. Therefore, a dual education and training model of diploma education and continuing pharmacist continuing education has been initially established in China. In particular, the education of clinical pharmacists is at a turning or breakthrough stage.

Clinical pharmacist service concept

The concept of rational drug use has been widely recognized within and outside the pharmacy community, and both pharmacy professional journals and public media have shown unprecedented enthusiasm for rational drug use. The search volume of the literature with the topic of "reasonable drug use" or "clinical pharmacy" is the full-text database of Chinese journals, with an annual growth rate of about 20%; some academic journals of clinical pharmacy have also been published and issued, such as earlier The "Chinese Journal of Clinical Pharmacy", which was founded in 1992 and the "Pharmaceutical Services and Research" sponsored by the Changhai Hospital of the Second Military Medical University in 2001, are professional journals that promote clinical pharmacy work and promote pharmacy services. In 2004, the "Chinese Journal of Clinical Pharmacy" and "Pharmaceutical Services and Research" also became the core periodicals of Chinese science and technology, which also reflected the increase in the quantity and quality of relevant literature. According to the literature published in recent years, domestic clinical pharmacists have started to investigate clinical medications and analyze prescriptions, and have gradually participated in clinical drug treatments, such as providing pharmaceutical information services, conducting therapeutic drug monitoring, monitoring adverse drug reactions, and clinical work under pharmacists. Especially in the clinical aspect of pharmacists, domestic clinical pharmacists have summarized and practiced a variety of clinical participation models, such as expert models (participating in clinical rounds, consultations and interpretation of therapeutic drug monitoring results), generalist models (satellite pharmacy work and information consultation) ) And various types of audits and inspections (medical examinations in wards, audits in intravenous preparation centers, and collection of adverse drug reactions).

Clinical pharmacist clinical pharmacist work system

In order to implement the spirit of the Ministry of Health's "Interim Provisions on the Administration of Pharmaceutical Affairs in Medical Institutions", in accordance with the implementation rules of the Hubei Provincial Department of Health's hospital grade review and the relevant regulations and requirements for the hospital's quality management year activities, explore the establishment of medical care and mutual care that suits the actual situation of the hospital Collaborate, improve the quality of medical work, standardize the working model of clinical pharmacists, and formulate these methods.

Clinical pharmacist Clinical pharmacist job responsibilities:

(1) Participate in the design and implementation of clinical drug treatment programs, assist clinicians in selecting and rationally using drugs, so that patients are not affected or reduced from drug-related damage, improve the level of clinical drug treatment, and improve the quality of life of patients.

(2) Develop pharmaceutical information and consulting services, conduct medication education, and promote and guide patients to use medication safely.

(3) Carry out clinical pharmacy research and provide scientific monitoring or experimental data to improve the level of drug treatment.

(4) Undertake clinical pharmacy education in hospitals and train pharmacists, physicians, and community physicians, and carry out medication education for patients.

Clinical pharmacist clinical pharmacist job content:

(1) In-depth understanding of drug application trends in clinical departments and suggestions for improvement of clinical application of drugs;

(2) Participate in rounds and consultations, participate in the treatment and treatment of critically ill patients, and make recommendations for drug treatment;

(3) Monitor therapeutic drugs and design individualized drug delivery plans;

(4) Instructing nurses to do a good job in collecting, keeping, and using medicines;

(5) Assist clinicians to make clinical observations after new drugs are launched, and collect, organize, analyze, and feedback drug safety information;

(6) Provide relevant drug consulting services and promote knowledge of rational drug use;

(7) Carry out drug evaluation and drug utilization research in combination with clinical drugs.

Clinical pharmacist Clinical pharmacist in-depth clinical work procedures:

(1) First visit the patient in the ward, or understand the general situation of the patient through the computer, and the latest examination data.

(2) Participate in medical rounds, put forward drug recommendations during rounds discussions; guide patients on medications, ask and observe the situation after medications, understand drug interactions, drug-food interactions, and ensure safe medication use, and record them in the pharmacist Written medicine history; if adverse drug reactions are found, enter the adverse reaction processing program; make comments on whether the patient needs blood concentration monitoring after the drug administration, analyze the blood drug concentration monitoring results, and formulate and adjust the dosing plan according to the parameters;

(3) Guidance on medication for special patients;

(4) Participate in the rescue of critically ill patients and guide medication on the spot;

(5) Provide medical advice to doctors, nurses and patients.

Clinical pharmacist clinical pharmacist participation in clinical work system and indicators:

(1) According to the duties of clinical pharmacists, clinical pharmacists should regularly go into clinical wards and participate in clinical drug treatment rounds, consultations, first aid and case discussions.

(2) The clinical pharmacist should make in-depth clinical rounds no less than 10 times each month, and no less than 2 hours each time;

(3) Clinical pharmacist rounds can be divided into two types: follow-up clinician rounds and clinical pharmacist rounds alone. Follow the clinician's rounds to understand the patient's condition and treatment difficulties. After the rounds, you should participate in the discussion of the medical team. Clinical pharmacists' rounds are mainly for patients with special conditions (such as adverse drug reactions, critically ill patients, complicated drug treatment and severe liver and kidney function impairment, etc.) for rounds. Clinical pharmacists can consult medical records and communicate with doctors to understand After the illness, ask the patient or accompanying person. Conduct separate pharmacy rounds at least once a week, establish drug history for key patients, and keep work records;

(4) Participate in the rescue and medical record discussion of critically ill patients and keep records. Before participating in the consultation, the clinical pharmacist should consult the medical records, ask questions, understand the condition, and conduct necessary data review and calculation to put forward scientific and prudent views to assist clinicians to improve the treatment effect. Clinical pharmacists should actively participate in and observe other relevant consultations in their clinical departments;

(5) Work summary is held every week, and a working meeting is held once a month to exchange experiences, information, and discuss difficult medicines;

(6) The clinical pharmacist should actively provide pharmacy information consultation, and actively respond to questions raised by doctors, nurses and patients. If no answers can be given at that time, they should be recorded in a timely manner, and afterwards consult the relevant experts or consult the information to give a satisfactory answer as far as possible. There should be detailed records of key consultations or typical questions, and a summary at the end of the year;

(7) Collect, sort, analyze, and feedback drug safety information, and do a good job of monitoring adverse drug reactions. Actively care and guide patients who have adverse reactions to help them improve medication compliance. Do not miss serious adverse drug reactions and publish 1 issue of drug news every quarter;

(8) Assist medical staff to do the design, application, sampling, interpretation of results and medication adjustment of therapeutic drug monitoring work according to clinical needs and drug characteristics, and actively do a good job of recording patient status and monitoring results records, accumulating group pharmacokinetic data.

(9) Combining clinical medications, actively carry out drug evaluation and drug utilization research such as medical records, prescription analysis, etc. Each year, establish a key medication research topic and write an investigation and analysis report; actively communicate with medical staff in various aspects, and find out the clinical needs Pharmacy research projects to promote the development of clinical pharmacy research; pharmacy education lectures are held at least once a year, with lecture notes, and more than one paper published publicly;

Clinical pharmacist assessment:

According to this method, the assessment of the appointment of clinical pharmacists is organized once a year, and the assessment results are recorded in the year-end assessment results.