CAJ | 학술논문

目的：通过临床药师在肾内科对药物整合（medication reconciliation）的实践，探讨临床药师在药物整合中的重要作用。方法对2014年1月18日－2月18日入院的20名患者进行药物整合，主要通过询问患者近1年内的用药情况，对比入院医嘱和药师询问结果，分析存在差异的原因。结果药品数量与入院医嘱不相符率占60％，药品产地不同占55％，药师问诊的准确率更高。结论临床药师在药物整合中起到重要的作用，通过加强医生和患者对药物整合的重视，以及加强医院系统网络建设等措施可以更好地帮助医务工作者实行药物整合服务，减少用药差错的产生。
목적：통과림상약사재신내과대약물정합（medication reconciliation）적실천，탐토림상약사재약물정합중적중요작용。방법대2014년1월18일－2월18일입원적20명환자진행약물정합，주요통과순문환자근1년내적용약정황，대비입원의촉화약사순문결과，분석존재차이적원인。결과약품수량여입원의촉불상부솔점60％，약품산지불동점55％，약사문진적준학솔경고。결론림상약사재약물정합중기도중요적작용，통과가강의생화환자대약물정합적중시，이급가강의원계통망락건설등조시가이경호지방조의무공작자실행약물정합복무，감소용약차착적산생。
Objective To discuss the important role of clinical pharmacists in medication reconciliation through the prac‐tice of clinical pharmacists of nephrology department .Methods The medication reconciliation serviced for the patients newly admitted to nephrology department was carried out through the way of interrogation .The difference and the causes between the results of pharmacist′s interrogation and the doctors′were analyzed .Results 20 patients were enrolled .The quantity was not consistent with what hospital doctor′s advice rate (60% ) ,drugs produced in different areas (55% ) ,different producing areas pharmacist had higher accuracy .Conclusion It had certain effect on medication management and could reduce the ADR .Clinical pharmacists and doctors should pay more attention on the medication reconciliation ,strengthen the ability of interrogation to im‐prove patient compliance and establish a complete medication reconciliation system .