Levenson Steven A, Saffel Dana A
J Am Med Dir Assoc. 2007 Jan;8(1):55-64. doi: 10.1016/j.jamda.2006.11.002.
Nursing homes must provide sophisticated medical and personal care to a broad spectrum of residents and patients. Medications are an increasingly important part of that care. The risks and benefits of medications are widely published, but not necessarily recognized in the care of individual patients. Decisions about medications must be made in the proper context of the patient. Medications are often indicated for various illnesses, symptoms, and risk factors, but clinically significant adverse consequences of medications are common and typically mimic common syndromes. Timely recognition and management of adverse consequences requires vigilance and a high index of suspicion. Many factors influence medication prescribing and use in the nursing home. Newly updated OBRA surveyor guidance emphasizes the importance of following the full care process in implementing, dosing, monitoring, and adjusting medications. Physicians and consultant pharmacists have prominent, complementary roles in addressing medications in the nursing home. The purpose of this article is to clarify these roles, identify their basis (primarily, the care process), and discuss how physicians and consultant pharmacists can collaborate effectively to optimize medication use and minimize preventable adverse consequences.
疗养院必须为广泛的居民和患者提供复杂的医疗和个人护理。药物在这种护理中发挥着越来越重要的作用。药物的风险和益处已广泛公布，但在个体患者的护理中不一定得到认可。关于药物的决策必须在患者的适当背景下做出。药物通常用于治疗各种疾病、症状和风险因素，但药物具有临床意义的不良反应很常见，且通常类似于常见综合征。及时识别和处理不良反应需要保持警惕并高度怀疑。许多因素影响疗养院中的药物处方和使用。最新更新的《综合预算协调法案》（OBRA）检查员指南强调了在实施、给药、监测和调整药物时遵循完整护理流程的重要性。医生和顾问药剂师在疗养院处理药物方面发挥着重要的互补作用。本文的目的是阐明这些作用，确定其依据（主要是护理流程），并讨论医生和顾问药剂师如何有效合作以优化药物使用并尽量减少可预防的不良反应。
