美國(měiɡuó)藥師藥學實踐北京大學第三醫院藥劑科楊麗第一頁，共二十七頁。ASHP對藥師(yàoshī)的定義

藥師(yàoshī)的任務是提供藥學保健，藥學保健是直接、負責地提供與藥物治療相關的保健，其目的是達到改善病人生命質量的確切效果。

2022/12/42北京大學第三醫院藥劑科第二頁，共二十七頁。美國藥師(yàoshī)的資格具有Pharm.D.學位通過全美藥師資格(zīgé)統一考試通過當地法律考試取得藥師執照直接工作(gōngzuò)

or

住院藥師培訓PharmacyResidencyProgram第三頁，共二十七頁。2022/12/43工作(gōngzuò)內容藥學院教師營養(yíngyǎng)支持藥師社區藥房藥師 腫瘤專科藥師普通制劑手術室藥師重癥監護藥師兒科專科藥師藥物信息藥房經營管理醫院藥房藥師毒物控制專科藥師醫院臨床藥師零售藥店藥師傳染疾病藥師精神專科藥師養老院藥師公共衛生服務藥學管理普通藥師部隊(bùduì)醫院藥師獸醫藥師核醫學專科藥師2022/12/44北京大學第三醫院藥劑科第四頁，共二十七頁。藥師(yàoshī)著裝－職業化職業服裝－白大褂整潔(zhěngjié)、干凈有利于控制交叉感染不允許穿便服和便鞋必須佩戴標明藥師姓名和醫療級別的身份牌提高藥師職業形象增加(zēngjiā)患者的信任感2022/12/45北京大學第三醫院藥劑科第五頁，共二十七頁。藥學服務(fúwù)的沿革PharmaceuticalCarePatientCareProcess I.患者評估(pínɡɡū)

PatientAssessment

II.監護計劃

Careplandevelopment III.隨訪評估

Follow-upevaluation2022/12/46北京大學第三醫院藥劑科第六頁，共二十七頁。PatientCareProcess

Buildarelationship!自我介紹簡述談話目的輕松(qīnɡsōnɡ)氣氛了解患者所需期望,治療目標,顧慮談話技巧開放式提問鼓勵傾聽總結“早上好！李先生。我姓楊，是主管你的住院藥師。我需要(xūyào)向您了解一些信息，以便更清楚地了解您的情況。您不介意我問一些問題吧？”2022/12/47北京大學第三醫院藥劑科第七頁，共二十七頁。I.患者(huànzhě)評估PatientAssessment 1.收集(shōují)相關信息

2.評估藥物治療相關需求 3.確定藥物治療問題

文件(wénjiàn)記錄PharmacotherapyWorkup?Notes所有病史及用藥史信息被歸納入一個結構化的表格中！2022/12/48北京大學第三醫院藥劑科第八頁，共二十七頁。PharmacotherapyWorkup?notes-ASSESSMENTpatientreasonforencounter:CONTACTINFORMATIONNameAddressCityStatePostalCodeTelephone(h)(w)(cell)e-mailPharmacyNameClinicName(tel)(tel)DEMOGRAPHICSAgeDateofBirthGender:M/FWeightHeightLeanBodyWeightPregnancystatus:Y/NBreastFeeding:Y/NDueDateOccupationLivingArrangements/FamilyHealthInsurance(coverageissues):2022/12/49北京大學第三醫院藥劑科第九頁，共二十七頁。SOCIALDRUGUSESubstanceHistoryofUseSubstanceHistoryofUseTobacco__Notobaccouse__0-1packsperday__>1packsperday__previoushistoryofsmoking__attemptstoquitAlcohol__Noalcoholuse__1-2drinksperweek__3-6drinksperweek__>6drinksperweek__historyofalcoholdependenceCaffeine__Nocaffeineuse__<2cupsperday__2-6cupsperday__>6cupsperday__historyofcaffeinedependenceOtherrecreationalDruguseALLERGIES&ALERTSMedicationAllergies(drug,timing,reaction--rash,SOB,angioedema,anaphylaxis)Adversereactionstodrugsinthepast(Intolerances)OtherAlerts/HealthAids/SpecialNeeds(sight,hearing,mobility,literacy,disability)2022/12/410北京大學第三醫院藥劑科第十頁，共二十七頁。CURRENTMEDIALCONDITIONS

ANDMEDICATIONSIndicationDrugProductDosageRegimendose,route,frequency,durationStartDateResponseeffectiveness/safetyPAST

DRUGTHERAPIESIndicationDrugTherapyResponseDate2022/12/411北京大學第三醫院藥劑科第十一頁，共二十七頁。PASTMEDICALHISTORY(relevantillnesses,hospitalization,surgicalprocedures,injuries,pregnancies,deliveries)PHARMACIST’SOBSERVATIONS(MEDICATIONEXPERIENCE)Whatisthepatient’sgeneralattitudetowardtakingmedication?NeedsattentionincareplanYNWhatdoesthepatientwant/expectfromhis/herdrugtherapy?NeedsattentionincareplanYNWhatconcernsdoesthepatienthavewithhis/hermedications?NeedsattentionincareplanYNTowhatextentdoesthepatientunderstandhis/hermedications?NeedsattentionincareplanYNAretherecultural,religious,orethicalissuesthatinfluencethepatient’swillingnesstotakemedications?NeedsattentionincareplanYNVitalSignsBP_______/_______HR_______bpmRespRate_______Temp_______2022/12/412北京大學第三醫院藥劑科第十二頁，共二十七頁。reviewofsystemsGeneralSystemsPoorappetite

GU/ReproductiveDysmenorrhea/menstrualbleedingWeightchangePainIncontinenceHeadacheImpotenceDizziness(vertigo)DecreasedsexualdriveEENTChangeinvisionVaginaldischargeoritchingLossofhearingHotflashesRingingintheears(tinnitus)Kidney/UrinaryUrinaryfrequencyBloodynose(epistaxis)Bloodyurine(hematuria)AllergicrhinitisRenaldysfunctionGlaucomaHematopoieticSymptomsExcessivebruisingBloodysputum(hemoptysis)BleedingCardiovascularChestpainAnemiaHyperlipidemiaMusculoskeletalBackpainHypertensionArthritispain(osteo/rheumatoid)MyocardialInfarctionOrthostatichypotensionTendonitisPulmonaryAsthmaPainfulmusclesShortnessofbreathNeuropsychiatricNumb,tinglingsensationinextremities(parasthesia)WheezingGastrointestinalHeartburnAbdominalpainTremorNauseaLossofbalanceVomitingDepressionDiarrheaSuicidalConstipationAnxiety,nervousnessSkinEczema/PsoriasisInabilitytoconcentrateItching(pruritis)SeizureRashStroke/TIAEndocrineSystemsDiabetesMemorylossHypothyroidismInfectiousDiseaseHIV/AIDSMenopausalSymptomsMalariaHepaticCirrhosisSyphilisHepatitisGonorrheaNutrition/Fluid/ElectrolytesDehydrationHerpesEdemaChlamydiaPotassiumdeficiencyTuberculosis2022/12/413北京大學第三醫院藥劑科第十三頁，共二十七頁。DrugTherapyProblemIdentification/Characterization

drugtherapyproblemsmedicalconditionanddrugtherapyinvolvedindicationUnnecessaryDrugTherapy__Nomedicalindication__Duplicatetherapy__Nondrugtherapyindicated__TreatingavoidableADR__Addictive/recreationalNeedsAdditionalDrugTherapy__Untreatedcondition__Preventative/prophylactic__Synergistic/potentiatingmedicalconditionanddrugtherapyinvolvedeffectivenessNeedsDifferentDrugProduct__Moreeffectivedrugavailable__Conditionrefractorytodrug__Dosageforminappropriate__NoteffectiveforconditionDosagetoolow__Wrongdose__Frequencyinappropriate__Druginteraction__DurationinappropriatemedicalconditionanddrugtherapyinvolvedsafetyAdverseDrugReaction__Undesirableeffect__Unsafedrugforpatient__Druginteraction__Dosageadministeredorchangedtoorapidly__Allergicreaction__ContraindicationspresentDosageTooHigh__Wrongdose__Frequencyinappropriate__Durationinappropriate__Druginteraction__IncorrectadministrationmedicalconditionanddrugtherapyinvolvedcomplianceNoncompliance__Directionsnotunderstood__Patientprefersnottotake__Patientforgetstotake__Drugproducttooexpensive__Cannotswallow/administer__Drugproductnotavailable2022/12/414北京大學第三醫院藥劑科第十四頁，共二十七頁。II.監護(jiānhù)計劃

CareplandevelopmentPharmacotherapyWorkup?notesCAREPLANINDICATION(medicalcondition)HISTORYOFTHEPRESENTILLNESSORMEDICALCONDITION(includingpreviousapproachestotreatmentandresponses)GOALSOFTHERAPY(improvementornormalizationofsigns/symptoms/laboratorytestsorreductionofrisk)1.2.DRUGTHERAPYPROBLEMStoberesolved

_____NoneatthistimeTherapeuticAlternatives(toresolvethedrugtherapyproblemandrationale)1.2.2022/12/415北京大學第三醫院藥劑科第十五頁，共二十七頁。PHARMACOTHERAPYPLAN(includescurrentdrugtherapiesandchangesbasedonbesttherapeuticalternativechoicefromabove)medications(drugproducts)dosageinstructions(dose,route,frequency,duration)noteschangesOtherinterventionstooptimizedrugtherapy:Scheduleforfollow-upevaluation:2022/12/416北京大學第三醫院藥劑科第十六頁，共二十七頁。III.隨訪(suífǎnɡ)評估

Follow-upevaluationPharmacotherapyWorkup?notesFOLLOW-UPEVALUATIONMedicalCondition(Indication):______________________________________OutcomeParameterPretreatmentBaseline(Date)FirstFollow-up(Date)SecondFollow-up(Date)EffectivenessSign/symptomSign/symptomLabvalueLabvalueSafetySign/symptomSign/symptomLabvalueLabvalueOther2022/12/417北京大學第三醫院藥劑科第十七頁，共二十七頁。statusSTATUSInitial:goalsbeingestablished,initiatenewtherapyResolve:goalsachieved,therapycompletedStable:goalsachieved,continuesametherapyImproved:adequateprogressbeingmade,continuesametherapyPartialImprovement:progressbeingmade,adjustmentsintherapyrequiredUnimproved:noprogressyet,continuesametherapyWorsened:declineinhealth,adjusttherapyFailure:goalsnotachieved,discontinuecurrenttherapyandreplacewithdifferenttherapyNewDrugTherapyProblemsIdentified__noneatthistime__documented__noneatthistime__documentedDateSchedulefornextfollow-upCommentsSignature___________________________Date_______________2022/12/418北京大學第三醫院藥劑科第十八頁，共二十七頁。ExcellenceInProgress2005Rankings:CollegesofPharmacy

RANK

Assessmentscore(5.0)1.UniversityofCalifornia--SanFrancisco4.62. UniversityofTexas--Austin 4.43. UniversityofNorthCarolina--ChapelHill4.24. PurdueUniversity 4.1UniversityofArizona 4.1UniversityofMichigan–AnnArbor 4.1UniversityofMinnesota–TwinCities 4.18. UniversityofKentucky 4.0UniversityofIllinois–Chicago 4.0UniversityofMaryland–Baltimore 4.02022/12/419北京大學第三醫院藥劑科第十九頁，共二十七頁。臨床(línchuánɡ)藥學實踐內容醫院藥學實踐(shíjiàn)

HospitalPharmacyPractice特殊患者藥學服務SpecialtyPopulationPractice藥師門診實踐AmbulatoryCarePractice社區藥學實踐CommunityPharmacyPractice零售藥店RetailPharmacyPractice養老院藥學實踐Long–termCarePractice2022/12/420北京大學第三醫院藥劑科第二十頁，共二十七頁。對藥師(yàoshī)的要求(1)藥學服務Service為患者提供最好的藥學服務作為不可缺少的治療團隊成員之一發揮重要作用正確應用循證思想(sīxiǎng)解決臨床用藥問題促進和支持安全有效的藥物使用成為藥學專業中的領導人才2022/12/421北京大學第三醫院藥劑科第二十一頁，共二十七頁。常規(chángguī)工作內容查房前準備－更新藥例基本信息;