Langebrake Claudia, Hilgarth Heike
Department of Stem Cell Transplantation and Pharmacy, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Pharm World Sci. 2010 Apr;32(2):194-9. doi: 10.1007/s11096-010-9367-z. Epub 2010 Jan 19.
To evaluate pharmaceutical interventions by ward-based clinical pharmacists in Germany.
Two ward-based clinical pharmacists working at the Departments of Stem Cell Transplantation and Intensive Care Medicine.
Pharmaceutical interventions during ward rounds from December 1st 2006 to November 30th 2008 were recorded and classified according to our own system that was adopted from established classification systems.
Classification of (1) cause of intervention, (2) intervention, (3) outcome of intervention and (4) initiator of intervention.
Altogether 2,312 interventions were documented. Besides 520 cases of information about drugs (rational selection, occurrence of infrequent adverse events or interactions), the main interventions were recommendations for the addition, the withdrawal or the replacement of a drug (n = 907, 50.6%) and advice for the change of dosage, dosing intervals or dose adjustment according to impaired renal or liver function (n = 584, 32.6%). The vast majority of the suggested interventions (92.8%) have been accepted.
The participation of a clinical pharmacist during ward rounds contributes to the optimisation of pharmacotherapy, in terms of choosing the most appropriate drug and/or the suitable dosage and may improve patient care.
评估德国病房临床药师的药学干预措施。
两名病房临床药师分别在干细胞移植科和重症医学科工作。
记录2006年12月1日至2008年11月30日查房期间的药学干预措施，并根据我们从既定分类系统采用的自身系统进行分类。
（1）干预原因、（2）干预措施、（3）干预结果和（4）干预发起者的分类。
共记录了2312次干预措施。除了520例关于药物的信息（合理选择、罕见不良事件或相互作用的发生）外，主要干预措施包括增加、停用或更换药物的建议（n = 907，50.6%）以及根据肾功能或肝功能损害调整剂量、给药间隔或剂量的建议（n = 584，32.6%）。绝大多数建议的干预措施（92.8%）已被采纳。
临床药师参与查房有助于优化药物治疗，在选择最合适的药物和/或合适剂量方面，并可能改善患者护理。
