美国临床药师的临床实践管见课件

美国临床药师的临床实践管见1精选ppt美国临床药师的临床实践管见1精选ppt内容提要美国医院从事药学技术工作的分类，配置的，比例和职责。美国的住院药师（在临床工作的，相当国内的临床药师）如何参与临床药物治疗工作，保证患者用药安全、合理用药的；制度、资质、工作流程、绩效、酬报等，有无书面的文书，如药历等。美国的住院药师在用药安全、合理方面做出的成绩，课题，数据等。2精选ppt内容提要美国医院从事药学技术工作的分类，配置的，比例和职责。美国临床药师资质本科药学管理硕士药学博士住院药师训练专业证书（BoardofPharmacotherapy)BoardCertifiedPharmacotherapySpecialistBoardCertifiedOncologySpecialistBoardCerfitifiedAmbulatoryCareSpecialistBoardCertifiedNutritionSupportSpecialistBoardCerfitifedPediatricSpecialistBoardCertifiedInfectiousDiseaseSpecialist3精选ppt美国临床药师资质本科3精选ppt美国临床药师分类政府机关教学机构保险公司医药公司的药物信息部医院住院部门诊（独立门诊和医院门诊）药店（独立或连锁）4精选ppt美国临床药师分类政府机关4精选ppt医院临床药师分类职能住院部中心药房普通病房专科病房（ICU,各个专科-心脏，肾脏，儿科，肿瘤，流行病，心理精神）门诊部内科和家庭医生门诊各个专科5精选ppt医院临床药师分类职能住院部5精选ppt推广临床药师的数据五个花钱最多的病症

糖尿病、心衰、高血压、高血脂、肺气肿五个返诊率最高的疾病

心肌梗死、心衰、肾衰、呼吸系统疾病、精神病五个门诊病人最集中的科室

心脑血管疾病、肿瘤、糖尿病、关节炎、肥胖6精选ppt推广临床药师的数据五个花钱最多的病症6精选ppt2010DiseaseTargets

GregoryDill,CentersforMedicare&MedicaidServices,RegionVAssociateRegionalAdministratorforFinancialManagementandFee-for-ServiceOperations7精选ppt2010DiseaseTargets

GregoryD2010MultipleChronicDiseases“Sponsorscannotrequiremorethan3chronicdiseases

astheminimumnumberofmultiplechronicdiseases”and“sponsorsmusttargetatleastfourofthesevencorechronicconditions:”HypertensionHeartFailureDiabetesDyslipidemiaRespiratoryDiseases(Asthma,COPD,ChronicLungdisorders)BoneDisease-Arthritis(Osteoporosis,RA,OA)MentalHealthissues(Depression,Schizophrenia,BipolarDisorder,others)GregoryDill,CentersforMedicare&MedicaidServices,RegionVAssociateRegionalAdministratorforFinancialManagementandFee-for-ServiceOperations8精选ppt2010MultipleChronicDiseasesHennepinCountyMedicalCenter药师配置465张病床药房管理人员-全职：主任，住院部经理，临床药学部经理，门诊部经理，特种药房经理，用药安全经理兼职：药物治疗学经理，住院药师经理，药学博士生经理，中心药房临床药师普通病房专科病房门诊药师普通门诊专科门诊住院药学博士技术员药学院学生9精选pptHennepinCountyMedicalCente临床药师参与医院工作介绍临床用药安全经理-用药安全医院用药安全决策（院办，临床药物治疗）领导各级用药安全委员会（用药安全，医疗事故，临床药学，护理）临床药物治疗经理-合理用药药物种类药物使用分析临床用药政策10精选ppt临床药师参与医院工作介绍临床用药安全经理-用药安全10精选p临床药师在用药安全上对医疗体系的影响患者出院药学查房案例分析11精选ppt临床药师在用药安全上对医疗体系的影响患者出院药学查房案例分析（危机）挑战In2007,multipleuntowardeventsoccurredtopatientsdischargedtonursinghomesComplaintsfromnursinghomepatientsaboutconfusingdischargeordersAugustananursinghomeBenedictinehealthcaresystemTransplantclinicOutpatientdialysisunitExtendedcare12精选ppt（危机）挑战In2007,multipleuntowa追根溯源Oneunitwithoneteamover12weeksDocumentmedicalrecordnumber,numberofmedications,timespentErrorswerereportedinHCMC’seventreportingsystemandtrackedbythemedicationsafetycommittee13精选ppt追根溯源Oneunitwithoneteamove追根溯源Reviewed37patientsdischargedtoSNF17dischargemedsperpatientAveragingabout20minutesperpatient,plusadditionalcommunicationtimewiththeteammembers,mostlyphysicians14精选ppt追根溯源Reviewed37patientsdisch追根溯源InvestigationconfirmsexistingproblemOfthe37patients,only3(8%)wereerror-freeCommonthemesnoted:Formulationerrors(extendedreleaseetc)InappropriateduplicatesIncorrectdoses(e.g.antibioticathalfdose,anticoagulantatdoublethedose)Missingmedications(e.g.missedBPmed)Insulindosingerrors(missingss,duplicateorders,etc)15精选ppt追根溯源Investigationconfirmsexi问题在哪里？MultipleresidentphysicianstakingcareofonepatientPhysiciansdonothaveenoughtimefordischargepaperworkMissingcoordinationatdischargeTheexistingEMRprocessesallowedforerrors.Note:MedRecwascompleted90+%ofthetime16精选ppt问题在哪里？Multipleresidentphysic相关文献Dischargeerrorsoftenresultedinreadmissionstothehospital1-3Medicationerrorsinterferewiththepatient’sconfidenceintheirmedicalservices41.GillespieU,AlassaadA,HenrohnD,etal.Acomprehensivepharmacistinterventiontoreducemorbidityinpatients80yearsorolder:arandomizedcontrolledtrial.ArchInternMed.2009;169(9):894-900.2.KoehlerBE,RichterKM,YoungbloodL,etal.Reductionof30-daypost-dischargehospitalreadmissionoremergencydepartment(ED)visitratesinhigh-riskelderlymedicalpatientsthroughdeliveryofatargetedcarebundle.JHospMed.2009;4(4):211-218.3.SchnipperJL,HamannC,NdumeleCD,etal.Effectofanelectronicmedicationreconciliationapplicationandprocessredesignonpotentialadversedrugevents:acluster-randomizedtrial.ArchInternMed.2009;169(8):771-780.4.BurroughsTE,WatermanAD,GallagherTH,etal.Patients'concernsaboutmedicalerrorsduringhospitalization.JtCommJQualPatientSaf.2007Jan;33(1):5-14.17精选ppt相关文献Dischargeerrorsoftenres减少患者再次入院率OneoutoffivepatientsdischargedfromaUShospitalwillbereadmittedin30days17.4billion(outof102.6billion,17%)ofMedicareannualcostJencks,SF,Williams,MV,Coleman,EA.RehospitalizationsamongPatientsintheMedicareFee-for-ServiceProgram.NEnglJMed2009;360:1418-1428.18精选ppt减少患者再次入院率Oneoutoffivepatie行动方案ReportedtothehospitalexecutivecommitteePresentedasolutionCollaboratedwithamultidisciplinaryteamMedicationsafetymanager19精选ppt行动方案Reportedtothehospitale执行方案Taketheadvantageofnewtechnology20精选ppt执行方案TaketheadvantageofnewPDSAModelLangleyGL,NolanKM,NolanTW,NormanCL,ProvostLP.TheImprovementGuide:APracticalApproachtoEnhancingOrganizationalPerformance

(2ndedition).SanFrancisco:Jossey-BassPublishers;2009:23-2421精选pptPDSAModelLangleyGL,NolanKMFailureModesandEffectsAnalysis(FMEA)IdentifypatientdischargingtoSNFatroundsSocialWorker(SW)obtainsbedandimmediatelypagesClinicalCoordinator(CC),MD,andPharmDMDhas4hourswithinwhichtowritethedischargeorders.Ifnotifiedafter2:00p.m.,MDmusthaveordersexceptI/Pdischargeinbefore8:00a.m.thenextday.CCscansordershourlyandpagesPharmD22精选pptFailureModesandEffectsAnaFMEAProcessPharmDandCChave2hourswithinwhichtocompletereview:PharmDreviewsmedicationorders.Ifissue,pagesMDtoreconcile.IfOK,sonotes:MarksasreviewedinMedRecscreenCCreviewsotherorders.Ifissue,pagesMDtoreconcile.CCchecksforI/Pdischarge;notifiesbedsidenurseandPSCwhenorderscompleted23精选pptFMEAProcessPharmDandCChav方案实施Individual1-1communicationbyPharmDtoorderingresidentandRNcoordinator.Communicationsenttoallattendingphysicians,notingthattheyareaccountabletoreviewresidents’dischargeordersandwillbenotifiediferrorsarefoundbypharmacists.24精选ppt方案实施Individual1-1communicati多边合作25精选ppt多边合作25精选ppt再检查PharmDreportserrors(nearmiss)usingeventreportingprocessNotifiedPM&IofthisriskNotifiedPatientCareV.P.’sReporttoExecutiveLeadershipTeam26精选ppt再检查PharmDreportserrors(near临床药学的大规模推广和应用MDDischargeOrdersPharmDandCCReviewSNFWithEPICupdate,Errorratewithoutreview-70%ofdischargesErrorrateafterreview-0%27精选ppt临床药学的大规模推广和应用MDDischargePharm病情危重与再入院率的关系

AllCauseReadmissionRelatedReadmissionSeverityofIllnessControlCaseControlCaseMinor14.29%(18/126)0%(0/1)7.94%(10/126)0%(0/1)Moderate19.03%(114/599)13.64%(3/22)7.85%(47/599)4.55%(1/22)Major26.54%(280/1055)31.37%(16/51)10.62%(112/1055)5.88%(3/51)Minor+Moderate+Major23.15%(412/1780)25.68%(19/74)9.49%(169/1780)5.40%(4/74)Extreme33.23%(104/313)38.46%(5/13)9.90%(31/313)23.08%(3/13)Overall24.65%(516/2093)31.03%(27/87)9.56%(200/1893)8.05%(7/87)Horn,SDetal.SeverityofIllnesswithinDRGs:Impactonprospectivepayment.AmJPublicHealth.1985;75,1195-928精选ppt病情危重与再入院率的关系

AllCauseReadmis患者再入院率29精选ppt患者再入院率29精选ppt临床药学对医疗质量的影响PhysiciansrequestittobeappliedtoallourpatientsImprovedpatientsatisfactionImprovedcustomerserviceReducedreadmissionrateby47%(5.7%vs10.2%)30精选ppt临床药学对医疗质量的影响Physiciansrequest经济分析HCMChasapproximately1850SNFdischargesperyear;witheachpatient,medicationreconciliationtakesonaverage24minutesinmind,thisequivalentto700hoursclinicalpharmacytimeannually.PharmaciststohelpwithmedicationreconciliationintheemergencyroomMedicationsafetymanager31精选ppt经济分析HCMChasapproximately185药事管理Costtoincreasestaffing $112,000Reductioninexpenses $587,000(ReducedReadmissionsby47%)TheUSpaymentsystemisintransitionfromafeeforservicetopayforperformance.ImprovedQualityforthePatient32精选ppt药事管理CosttoincreasestaffingInstituteforSafeMedicationPractices

2010CheersAward33精选pptInstituteforSafeMedicationTheJointCommissionNationalPatientSafetyGoals国家认证“…theNPSGonreconcilingmedicationinformation(originallyNPSG.08.01.01,butnowNPSG.03.06.01)wasstreamlinedandfocusedtoplaceaspotlightoncriticalriskpointsinthemedicationreconciliationprocess.NPSG.03.06.01iseffectiveJuly1,2011”./assets/1/18/National_Patient_Safety_Goals_6_3_111.PDF3