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

美國藥學的課程設置導論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藥房實踐模塊一

模塊二醫(yī)學課程一醫(yī)學課程二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年預科學習、4年藥學系統(tǒng)學習并獲PhD的學生PGY1：一年全職管理并改進藥品使用環(huán)節(jié)與醫(yī)生組成醫(yī)療團隊，以病人為中心，提供藥物治療服務醫(yī)藥實踐相關管理培訓PGY2：一年全職為?？苹颊哌M行專科藥學服務。導師為每位住院藥師提供個性化的教育目標和培訓方案。在心血管科、重癥監(jiān)護、藥物信息管理、老年病、感染病、內(nèi)科、營養(yǎng)支持、用藥管理、用藥安全等領域培訓，使住院藥師成為該領域的藥物治療專家加強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服務作為一種事業(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)生交班會加強與臨床醫(yī)生溝通的機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

臨床思維基礎藥物患者

病原體臨床思維要點

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肺癌并發(fā)肺部真菌感染診治的臨床思維關注患者的臨床表現(xiàn)：發(fā)熱、咳嗽；肺部聽診明確診斷標準：相關指南關注病原學檢查和發(fā)病誘因