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目的:探索临床药师向神经内科老年患者提供药学服务的切入点及工作体会,以提高老年人用药安全。方法:结合临床药师在神经内科参与制定SAP患者抗菌治疗方案、老年人用药剂量、围术期抗栓药物的应用以及提高患者依从性的典型案例讨论,总结药学服务工作实践经验体会。结果:临床药师通过会诊或主动监护上述典型病例,与医师形成一个治疗团队,在患者的住院治疗中发挥了作用,提高了临床治疗的有效性及合理性。结论:临床药师要从传统、被动的药学思维模式转变为以疗效与用药安全的临床思维模式,积极、主动地结合临床,才能及时发现并解决用药中出现的问题,联合医师选择更合理的治疗方案,体现其在临床诊疗中的价值地位。
Objective: To explore clinical pharmacists to provide medical services to elderly patients in neurology point of entry and work experience to improve the safety of the elderly medication. Methods: The clinical pharmacists were involved in the development of antimicrobial therapy in patients with SAP, the dosage of drugs for the elderly, the application of perioperative antithrombotic drugs and typical cases to improve patient compliance. Results: The clinical pharmacists formed the treatment team with doctors through consultation or active monitoring of the typical cases mentioned above, and played a role in the hospitalization of patients and improved the effectiveness and rationality of clinical treatment. Conclusion: The pharmacist should change from the traditional and passive mode of thinking to clinical thinking mode of efficacy and medication safety. Actively and proactively combine clinical practice to find out and solve the problems in the medication timely. Program, reflecting its value in clinical diagnosis and treatment.