臨床藥師如何培養(yǎng)臨床思維更好為患者提供合理用藥依據(jù)課件

美國藥學(xué)的課程設(shè)置導(dǎo)論HumanStructure(3hours;39totalhours)PharmacistPatientCareExperiencesIDosageforms(totalhours:52)sitevisits:0hourscampus:52hoursPharmaceuticsw/Lab(5hoursdidactic/3hourlab/4hoursOTC;156totalhours)EvidenceBasedMedicineI(3hours;39totalhours)Pharmacy&theUSHealthcareDeliverySystem(3hours;39totalhours)EvidenceBasedMedicineII(2hours;14totalhours)MoleculestoCells(16hours;112totalhours)PharmacistPatientCareExperiences2Dosageforms(totalhours:42)sitevisits:4hrs/wkx6wks=24hrscampus:18hrs模塊三

模塊四

模塊五PhysiologicalBasisofMedicine(16hours;112totalhours)ParenteralProductsw/Lab(3hours;21totalhrs))hours)PharmacistPatientCareExperiences3Dosageforms(totalhours:35)sitevisits:4hrs/wkx6wks=24hrscampus:11hrsPharmacistPatientCareExperiences4Dosageforms(totalhours:64)sitevisits4hrs/wkx6wks=24hrscampus:40hrsBrain,Mind&Behavior(16hours;128totalhours)MedicationUseSystems(2hours;14totalhours)Nutraceuticals(4hours;28totalhours)PharmacistPatientCareExperiences5MedicationDistribution(totalhours:14)sitevisits:0hrscampus:14hrsInfection&Immunity(16hours;112totalhours)PharmacyManagementOperations(4hours;36totalhours)ProfessionalElectives(1.5hours;14totalhours)PharmacistPatientCareExperiences6MedicationDistribution(totalhours:72)sitevisits:8hr/wkx8wks=64hrscampus:8hrsPrinciplesofDrug/BodyInteraction(10.5hours;95totalhours)PharmacistPatientCareExperiences8[titled7bforspring2010]MedicationDistribution(totaltime:100)sitevisits:8hrs/wkx8wks=64hrscampus:36hrsPharmacistPatientCareExperiences7MedicationDistribution(totalhours:100)sitevisits:8hrs/wkx8wks=64hrscampus:23hrsPharmacyManagement;Personnel(2hours;40totalhours)Pharmacotherapeutics&PracticeofPharmacyI(12hours;240totalhours)Pharmacotherapeutics&PracticeofPharmacyII(15hours;240totalhours)PharmacistPatientCareExperiences9MedicationSafety(totalweeks:12)(totalhours:72)site:8hrs/wkx8wks=64hrscampus:8hrsPharmacyLawandEthicsI(1hour;16totalhours)ProfessionalElective(2hours;32totalhours)PharmacistPatientCareExperiences10MedicationSafety(totalweeks:12)(totalhours:72)site:8hrs/wkx8wks=64hrscampus:22hrsPharmacotherapeutics&PracticeofPharmacyIII(15hours;315totalhours)PharmacyLawandEthicsII(1hour;21totalhours)ProfessionalElective(2hours;42totalhours)ImpactofChemicalDependency(33totalhours)

AdvancedPharmacyPracticeExperiences

Months

Rotation 2 AmbulatoryCare 2 Inpatient/AcuteCareGeneralMedicine 1 CommunityPharmacy 1 Hospital/Health-SystemPharmacy 1 SelectiveLeadership(CommunityorHospital) 1 Selective(PediatricorGeriatricMedicine) 1 Underserved 1 ElectiveElectives:

Cardiology,Oncology,PsychiatricMedicine,InfectiousDiseases,CriticalCare,Informatics,AdvancedCompounding,ProfessionalAssociationManagement,PublicHealthService,AdditionalTBD

HumanDevelopmentandStructureMoleculestoCells

PhysiologicalBasisofMedicineBrain,MindandBehavior

InfectionandImmunityLongitudinalLongitudinalLongitudinalLongitudinalLongitudinalPrinciplesofMedicineLongitudinalPrinciplesofMedicineLongitudinalCoreClerkshipsCoreClerkshipsLongitudinalLongitudinal

SixRequiredAdvancedElectivesLongitudinal藥房實(shí)踐模塊一

模塊二醫(yī)學(xué)課程一醫(yī)學(xué)課程二Pharmacy-BlockSixBlockSevenBlockEightBlockNineMedicine–StepThreeStepFourPharmacy–YearFourClinicalEpilogue&CapstoneMedicine–Step5美國住院藥師畢業(yè)后培養(yǎng)體制資格：經(jīng)2-4年預(yù)科學(xué)習(xí)、4年藥學(xué)系統(tǒng)學(xué)習(xí)并獲PhD的學(xué)生PGY1：一年全職管理并改進(jìn)藥品使用環(huán)節(jié)與醫(yī)生組成醫(yī)療團(tuán)隊(duì)，以病人為中心，提供藥物治療服務(wù)醫(yī)藥實(shí)踐相關(guān)管理培訓(xùn)PGY2：一年全職為?？苹颊哌M(jìn)行專科藥學(xué)服務(wù)。導(dǎo)師為每位住院藥師提供個(gè)性化的教育目標(biāo)和培訓(xùn)方案。在心血管科、重癥監(jiān)護(hù)、藥物信息管理、老年病、感染病、內(nèi)科、營養(yǎng)支持、用藥管理、用藥安全等領(lǐng)域培訓(xùn)，使住院藥師成為該領(lǐng)域的藥物治療專家加強(qiáng)臨床藥師臨床思維培養(yǎng)顯得尤為緊迫！

內(nèi)因：發(fā)揮臨床藥師的積極主觀能動性將臨床藥學(xué)服務(wù)作為一種事業(yè)去發(fā)展，而非僅僅是工作途徑1：藥歷的書寫是培養(yǎng)臨床思維的重要途徑等同于醫(yī)生病歷信息量豐富，便于梳理患者臨床信息途徑2：參與臨床醫(yī)生交班會加強(qiáng)與臨床醫(yī)生溝通的機(jī)會可以掌握大量臨床查房未能獲得的患者重要信息年輕藥師應(yīng)積極參與肺部感染抗菌藥物使用的臨床思維

臨床思維基礎(chǔ)藥物患者

病原體臨床思維要點(diǎn)

藥物選擇劑型和給藥途徑劑量調(diào)整給藥間隔和次數(shù)療程療效和不良反應(yīng)肺癌并發(fā)肺部真菌感染診治的臨床思維關(guān)注患者的臨床表現(xiàn)：發(fā)熱、咳嗽；肺部聽診明確診斷標(biāo)準(zhǔn)：相關(guān)指南關(guān)注病原學(xué)檢查和發(fā)病誘因