Joke Collection Website - Bulletin headlines - Good news! Pharmacists can sit in the consulting room, write prescriptions and have a "registration fee"!

Good news! Pharmacists can sit in the consulting room, write prescriptions and have a "registration fee"!

Recently, Guangdong Pharmaceutical Society issued "Trial Standards for Pharmacy Outpatients". Pharmacists can not only sit in the pharmacy clinic, but also have some prescription rights and "registration fees"! Let's take a look at the detailed document notice! With the gradual advancement of comprehensive reform measures in public hospitals, pharmaceutical services in medical institutions are facing new opportunities and challenges. In order to meet the requirements of reform and further strengthen pharmaceutical affairs management, we must promote the transformation of pharmacy service model and safeguard people's health rights and interests. The practice in developed countries has proved that pharmacists can directly provide pharmaceutical services to patients by setting up pharmaceutical clinics, which has a significant effect on improving the level of drug treatment and reducing the cost of drug treatment. It is of great significance to carry out pharmacy outpatient service to accelerate the development of clinical pharmacy and help the transformation of hospital pharmacy. In order to promote and standardize the healthy development of pharmacy clinics in medical institutions, the following trial standards are proposed. I. Policy Basis Providing services directly to patients through outpatient service is an important breakthrough point for pharmacists to improve their clinical core competitiveness. The Notice of the National Health and Family Planning Commission on Strengthening Pharmaceutical Affairs Management and Changing Pharmaceutical Service Mode (Guo Wei Ban Yi Fa [2017] No.26) suggests that qualified medical institutions can set up pharmacist consultation clinics to provide patients with medication consultation and guidance; One of the indexes of pharmaceutical service ability stipulated in the National Standard for the Establishment of Regional Medical Centers (General Hospitals) is that the number of patients served by "pharmaceutical clinics" is greater than or equal to 200 each year; The Evaluation Index of High-level Hospitals (General Hospitals) in Guangdong Province issued by the Guangdong Provincial Health Planning Commission requires pharmacy outpatient service to be ≥2 majors; In order to promote medical institutions to carry out pharmacy outpatient service, Guangdong Pharmaceutical Association issued the Notice on Promoting Pharmacy Outpatient Service in April 20 17 (Guangdong Pharmaceutical Association [2017] No.26). Second, the purpose of setting up pharmacy outpatient service is to improve the results of drug treatment for patients: 1. Clinical outcome: Pharmacists in pharmacy outpatient department can improve patients' medication compliance and therapeutic effect and reduce the occurrence of adverse reactions by guiding patients to take drugs and carrying out follow-up and pharmaceutical services. 2. Humanistic achievements: pharmacists in pharmacy outpatient department provide humanistic care for patients and improve their satisfaction with drug treatment; 3. Economic Outcome: Pharmacists in pharmacy outpatient department can reduce drug-related damage and unnecessary drug treatment by collecting patients' medication information and recombining drugs, and reduce the economic burden of medical insurance departments and patients' disease treatment. Third, the hardware requires a fixed clinic in the outpatient building. There are regular visiting hours every week. The clinic computer is equipped with outpatient visiting system, inpatient medical record system and pharmacy system, which can query the diagnosis, inspection, examination, medication and other information of patients' outpatient and inpatient. Conditional medical institutions should be equipped with pharmacists' workstations to manage patients' files. Four. Job Requirements and Responsibilities: Clinical pharmacists in pharmacy outpatient department should receive standardized training of clinical pharmacists and obtain the post training certificate of clinical pharmacists, or have the qualification certificate of "drug therapy management" certified by Guangdong Pharmaceutical Society, or have the senior professional title qualification of engaging in clinical pharmacy for at least 2 years. Responsibilities mainly include: collecting and establishing patient medication management files, including current history, past history, medication history, allergy history and adverse reaction history; Living habits and diet; Birth, surgical plan, etc. Organize the current medication situation and make personal medication records, including prescription drugs/over-the-counter drugs, Chinese herbal medicines, health care products, etc. , so that patients can carry out home medication management and provide medication information to other medical staff when seeking medical treatment. Evaluation of drug treatment efficacy and adverse drug reactions and other related issues; In view of the problems related to the patient's current drug treatment, appropriate interventions should be made, such as prescription simplification, drug reorganization and/or lifestyle adjustment or dietary improvement suggestions, or communication with the patient's attending physician for drug treatment intervention. Provide individualized medication education to enhance patients' understanding of drugs and enable them to use drugs correctly. Pharmacists in pharmacy outpatient service should actively participate in clinical teams, understand the current clinical treatment status of medical institutions, master the latest disease treatment methods through domestic and foreign guides, knowledge and literature, and improve pharmacy outpatient service in practice. Five. Customers and promotion of patients with one or more chronic diseases who receive multi-system and multi-specialty treatment at the same time; Such as chronic kidney disease, hypertension, coronary heart disease, hyperlipidemia, diabetes, gout, asthma, chronic obstructive pulmonary disease, osteoporosis, peptic ulcer and other diseases; Patients taking high-risk drugs, including drugs used to treat window stenosis, such as anticoagulants, phenytoin and methotrexate; Patients taking 5 or more drugs at the same time (including prescription drugs and over-the-counter drugs, Chinese herbal pieces and other health care products); Special groups such as the elderly, children, pregnant women and lactating women; Abnormal laboratory examination, these abnormal suspicious patients are related to drugs; Patients with recent adverse medical events (drug-related or non-drug-related) while receiving treatment; Patients who have doubts about drug treatment. The promotion forms of patients can be diversified, such as: referral by doctors or other medical personnel; Educate patients who take medicine in pharmacies or leave hospitals and distribute leaflets; Public media promotion, pharmaceutical science popularization, etc. Sixth, the solution of prescription right Because pharmacists have no prescription right, it is an effective way to solve the prescription right of foreign pharmacists by reaching an agreement with doctors. In developed countries such as Europe and America, pharmacists are mainly responsible for antithrombotic work, while pharmacists directly adjust prescriptions for patients in antithrombotic (anticoagulant) clinics. Domestic medical institutions have reached an agreement with doctors (Recommended Text of Anti-thrombotic Treatment Agreement between Pharmacists and Doctors, Guangdong Pharmaceutical Association [20 17]No. 15) to realize the problem of pharmacists' right to directly adjust prescriptions for patients. It is suggested that pharmacists in pharmacy outpatient department should be given some prescription rights (such as issuing inspection rights), which should be examined and approved by the medical department for the record. Seven. Types of outpatients At present, domestic medical institutions have opened independent pharmacy clinics or medical-pharmaceutical clinics according to the characteristics and needs of their own specialty development. Outpatient types include anticoagulation treatment management outpatient service, atrial fibrillation outpatient service, precise medication outpatient service based on medication management, and pharmacy outpatient service for specialized patients, such as outpatient service for respiratory patients, pharmacy outpatient service for chronic obstructive pulmonary disease and asthma, combined outpatient service for menopause, and medication for special groups (pregnant women, children, the elderly, etc.). ). Eight. The fee standard 20 13 World Pharmaceutical Congress clearly pointed out that pharmaceutical services without payment are unsustainable. Moreover, from the historical experience of developed countries, reasonable fees are an inevitable requirement for the benign and sustainable development of professional and technical services. The United States has incorporated drug treatment management services into the government medical insurance Medicare D plan. In order to ensure the sustainable development of pharmaceutical services, each medical unit should set up a charge pharmacy clinic, or set up a free pharmacy clinic first, so as to finally realize the charge (Notice on Promoting Pharmaceutical Outpatient Services [2017] No.26). It is suggested that the charge of pharmacy outpatient service should be implemented according to the current pharmacy service charge standard. Nine. The service content refers to the MTM model in the United States, and combined with the actual situation of medical institutions in China, the pharmaceutical outpatient service content is: 1. Drug therapy review (MTR). Establish patient information files (the specific work form depends on the work content, such as work records related to chronic disease management, see Schedule 2), review the medical history and medication history, and evaluate drug treatment and adverse drug reactions and other related issues. 2. Make a personal medication record (PMR) for patients. Organize the current medication situation and make a personal medication record (Table 3), including prescription drugs/over-the-counter drugs, Chinese herbal medicines, health care products, etc. , so that patients can carry out home medication management and provide medication information to other medical staff when seeking medical treatment. 3. Put forward the action plan (MAP) related to drug treatment. According to the problems (drug-related problems, MRPs) existing in the patient's current medical treatment (Appendix 1), or the lifestyle or diet that needs to be adjusted, take appropriate intervention measures, such as prescription simplification, drug reorganization and/or lifestyle adjustment or dietary education suggestions, and talk with him if necessary. 4. Provide individualized medication education to enhance patients' understanding of drugs and enable them to use drugs correctly. 5. Answer patients' questions about medication. 6. Follow-up visit, follow-up medication and make an appointment for follow-up. X. Admission process The admission process of the pharmacy clinic is as follows (Figure 1): 1. First-time patients: ① patient information collection: establish patient information files, and basic information includes: current medical history, past medical history, medication history, allergy history and adverse reaction history; Living habits and diet; Birth, surgical plan, etc. (2) Evaluation of medication plan: Evaluate the medication plan, curative effect and whether there are any adverse reactions for each disease; Assess whether patients have problems related to drug treatment (attached table1); Assess patients' knowledge and compliance with diseases and drugs. ③ Medication intervention: Intervene appropriately on medication-related issues, such as prescription simplification and drug reorganization, and communicate with the patient's attending physician when necessary. Make a personal medication record table to facilitate the patient's home medication management and provide medication information to other medical staff when seeking medical treatment. ④ Medication education: individualized medication education, lifestyle adjustment suggestions and diet education were given to patients, and relevant publicity materials were distributed. ⑤ Verify patients' understanding and acceptance of pharmacists' suggestions, and investigate their satisfaction. ⑥ Sort out the data and input it into the computer, regularly check the patient's examination results and new prescriptions, follow up by telephone and make an appointment for the next visit. 2. Non-newly-diagnosed patients: call up patient information files and re-evaluate drug-related problems according to patients' diseases and drug use changes (starting from item 2 in 1 above). Attachment download1-3 > & gt attachment 1: categories and common causes of problems related to drug therapy attachment 2: pharmaceutical outpatient record form attachment 3: patient medication list.