Discussion on pharmaceutical service and its present situation Pharmaceutical service is a hot spot in the field of hospital pharmacy at home and abroad in recent years. It is an important link in the implementation of medical prevention and treatment in hospitals, and it is also an important aspect of the reform of pharmaceutical work mode in the 2 1 century. Modern hospital pharmacy will change from drug supply management to pharmaceutical service. With the development of social organizations and the renewal of ideas, health needs pharmaceutical services, which is also the way out for traditional pharmacists in China. In the past, pharmacists had little contact with patients, and the task of pharmacists was to adjust and supply drugs. With the development of hospital pharmacy, especially the rise of clinical pharmacy, this situation is also undergoing fundamental changes. The development of hospital pharmacy has experienced three periods: traditional dispensing period, clinical pharmacy period of pharmaceutical service and pharmaceutical service period of improving patients' quality of life. The three main contents of pharmaceutical care are: pharmacists' participation in clinic, monitoring of therapeutic drugs and drug information consultation. Pharmacists' participation in clinic will enable pharmacists to directly establish contact with patients and directly participate in formulating drug treatment plans, which is a fundamental change in pharmacists' functions, which means that pharmacists should assume the responsibility of guardianship over the whole process of patient treatment. Drug therapy can relieve pain and bring happiness to many patients, but it can also cause drug harm, sequelae and even death to many people. In fact, most problems are not caused by drugs themselves, but by incorrect prescription, dispensing or administration. Therefore, pharmacists have the moral responsibility to protect patients from drug harm. With the change of people's health concept, the requirements for the quality of treatment and life are constantly improving. They are not satisfied with the availability of drugs, but require to enjoy high-quality, safe, reasonable and economical services. Therefore, pharmaceutical care has become an inevitable trend. [1] 1. Definition of pharmaceutical service Pharmaceutical service is a process. Pharmacists cooperate with patients and other professionals to design treatment plans, and their implementation and monitoring will have special therapeutic effects on patients. It includes three functions: ① finding potential or actual medication problems; ② Solve the problem of actual medication; ③ Prevention of potential medication problems. The unified definition of pharmaceutical services is: "The mission of pharmacists is to provide pharmaceutical services. Pharmaceutical care is to provide direct and responsible drug-related care, with the aim of improving the quality of life of patients "[2]. The work of pharmacists should be directly oriented to patients, and bear the social responsibility of supervising, implementing and ensuring patients' safe and effective medication, so as to improve patients' physical and mental health to the greatest extent. 2. The main content of pharmaceutical care. 1. organically combine medical treatment, pharmacy and nursing, so that doctors, pharmacists and nurses can work together and share medical responsibilities. 2, 2, not only for patients, but also for the national health education of the whole society. 2, 3, guide and help patients and medical staff to use drugs safely, effectively and reasonably. 2, 4, regular scientific evaluation of drug use and management. It can be seen that the working mode of hospital pharmacists will change. They should not only prepare drugs, but also directly face patients, participate in treatment, guide medication, and work with doctors and nurses in the clinical front line. 3. The responsibilities and tasks of pharmacists in pharmaceutical care. 1. Work with doctors to decide whether the patient needs medication, define the treatment goal, design a medication plan for this goal, monitor the whole process of patient medication, comprehensively evaluate medication, find and report drug allergic reactions and side effects, and minimize the occurrence of adverse drug reactions and harmful drug interactions. 3, 2, comprehensive management of all resources needed for pharmaceutical services, including personnel and drugs. 3, 3, to ensure rational drug use, that is, safe, effective and economical drug use, according to the patient's disease type, nature, onset time, past drug use history, whether there is drug allergy, etc. Choose safe and effective drugs, appropriate dosage forms, ways and methods of administration. The specific task of pharmacists in providing pharmaceutical services is to find, prevent and solve problems related to medication. For example, ① the drug is correct; ② Appropriate indications for medication; ③ Safe curative effect and reasonable price; ④ Appropriate dosage, usage and course of treatment (determine the dosage and course of treatment according to the knowledge of pharmacokinetics and pharmacodynamics); ⑤ Appropriate drug users (no contraindications, few adverse reactions); ⑥ correct deployment; ⑦ Patients have good compliance. [3] 4. The position of hospital pharmacists in pharmaceutical care. 1. The client of the pharmacist is the patient as the client of the patient, and the pharmacist must establish a "one-to-one" business relationship with the patient. 4. 2. Establishing a new partnership of "prescription, pharmacist and patient" Pharmaceutical service requires breaking the internal division of labor in pharmacy, such as "pharmacy pharmacist" and "preparation pharmacist". All pharmacists must bear the responsibility of patient care, and all staff in the pharmaceutical department are regarded as providers of patient care. Other medical staff and patients can talk directly with pharmacists, play an extended role as doctors and become a member of the treatment team. [4] 5, the importance of pharmaceutical care, first of all, it promotes the rational use of drugs and improves the therapeutic effect of drugs. Secondly, it reduces the adverse reactions of drugs and can prevent the occurrence of some drug-induced diseases. Thirdly, the patients' diseases are cured, and the symptoms are eliminated or alleviated, thus achieving the fundamental purpose of improving the quality of life of patients and prolonging their lives. Fourthly, by reducing or eliminating irrational drug use, drug resources are saved. Clinical pharmacy started late in China, but pharmaceutical care is in the publicity period. However, irrational drug use is common in China, and the unqualified prescriptions in some primary hospitals are as high as 60%, which is a serious problem. Pharmaceutical service is the inevitable trend of hospital pharmacy development in 2 1 century. 6. Obstacle [3,4,5] 6, 1, conceptual obstacle 6, 1, 1 The implementation of pharmaceutical services in China has surpassed the traditional work of pharmacists, and it is difficult for pharmacists to adapt to the major shift from "responsible for ensuring the quality and supply of drugs" to "responsible for the patient's medication results", especially at present, drug treatment decisions are made by doctors. 6, 1 2, beyond the concept of curing diseases, the service provided by PC is not only to cure patients' existing diseases, but also to restore patients' health, so that patients can maintain good physical function and mental state and live a healthy and happy life. 6, 1, 3. The concept of evaluating treatment outcome beyond biological indicators. At present, the indicators for evaluating the therapeutic effect of drugs are only some observation data. For example, when anticancer drugs are given to cancer patients, how many years have the life span of the patients been extended as an index to evaluate the quality of treatment. However, behind the pharmacological effects of anticancer drugs, the serious side effects of drugs (deterioration of quality of life) have not been taken into account. To carry out PC work, it is necessary to comprehensively evaluate the influence of drugs on patients' overall function and quality of life. 6, 1, 4, beyond the narrow geographical concept of specific medical institutions 6, 1, 5, beyond the current division of medical business. Although the division of labor is different, the overall goal is the same. All pharmaceutical staff in the hospital provide services to improve the quality of life through drugs and pharmaceutical means. 6, 2, obstacles in medical resources 6, 2, 1, lack of time. At present, pharmacists in China have to spend a lot of time on routine drug supply, that is, pharmacists in pharmacies who have the most clinical contact, and it is difficult to focus on ward rounds, attending meetings, consulting medical records, drug consultation, drug monitoring, and suggesting adjustments. In addition, pharmacists don't have enough time to ensure that they read all drugs within 24 hours after administration. 6, 2, 2, personnel restrictions Most of the pharmacy staff in hospitals in China are low and the personnel structure is complex. In addition, pharmacists' clinical knowledge is relatively lacking, so it is impossible to carry out time-consuming and laborious pharmaceutical monitoring. 6, 2, 3 Limited workplaces and technical conditions At present, the infrastructure of hospitals in China has been greatly improved, but it is not yet possible to set up a workplace for PC pharmacists in every clinical department. In addition, the current economic situation of hospitals generally introduces expensive new technologies and equipment unconditionally. 6, 3, obstacles in the medical system The existing medical system has a high degree of division of labor. The consistency of pharmaceutical services requires the medical system to be a complete system, and this division of labor must be changed. 6.4. Obstacles in information resources. 4. 1. Insufficient medical information. Pharmacists who provide pharmaceutical services should not only be able to obtain drug knowledge and latest information in time, but more importantly, they should be able to obtain patients' medical documents (past medical history, course records and so on). ). It is often difficult for pharmacists to obtain this information, so it is necessary to solve the problem of sharing medical information. 6, 4, 2, pharmacists lack experience in writing medical documents. The professional knowledge of pharmacists focuses on drug research and lacks clinical experience and skills. 6, 5, legal obstacles The traditional task of hospital pharmacists is mainly to purchase and supply drugs and distribute drugs by the recipient. Pharmacists can only carry out business activities within the scope of their functions and powers under the conditions permitted by laws and regulations. To carry out pharmaceutical care business, it is necessary to formulate the Pharmacist Law and add corresponding clauses in relevant laws and regulations. 7, pharmaceutical service is imperative [1, 3] Although pharmaceutical service is still in the stage of publicity and introduction, it is very difficult to implement, but pharmaceutical service has been widely concerned by pharmaceutical scholars and hospital pharmacists. Reasons ① The objective conditions for the development of pharmaceutical care have been gradually formed. With the improvement of people's living standards, the demand for medical care, especially medication, has risen to the height of improving the quality of treatment and even the quality of life. Therefore, the objective conditions for carrying out this work have gradually formed; (2) The traditional drug supply mode in hospitals has changed, and the pharmaceutical industry has developed in a large scale and with high quality, and hospital preparations will gradually decrease and shrink; The modern management of pharmacy department has fundamentally changed the traditional drug supply mode of hospitals; (3) Using computers, the pharmacy is overstaffed. Therefore, if we don't think about reform and progress and stand still, the fate of "being laid off" will fall on traditional pharmacists, and people need pharmaceutical services, which is also the next way out for hospital pharmacists. We should start with renewing our own ideas, correctly publicize pharmaceutical services, understand pharmaceutical services, consciously and actively strengthen our own learning, adapt to pharmaceutical services, clear all kinds of obstacles on the way forward for the implementation of pharmaceutical services in China, and strive to create a big environment in which pharmaceutical services are gradually rooted in the hearts of the people and develop healthily. Hospital pharmacists in the future should know both medicine and clinic, and their basic work includes: monitoring and interpretation of blood drug concentration, clinical treatment consultation, single-dose operation, medication education for patients after discharge, medication consultation for outpatients, monitoring and identification of adverse drug reactions, development of new scientific research preparations, and participation in the formulation of clinical evaluation schemes for new drugs. Give full play to the professional expertise of pharmacists, ensure the ideal medication effect, and reduce the medical expenses related to drugs. As far as possible, every patient can maintain normal physical function and mental state and live a healthy and happy life after receiving drug treatment. [6] Refer to Gao Gao's New Stage of Pharmaceutical Development-China Journal of Pharmacist Monitoring,1995,30 (2): 97, and China Journal of Hospital Pharmaceutical Monitoring and Clinical, 196,16 (16). 1996, 16 (9): 393 Tang Jingbo's Supervision and Guidance on the Integration of Drug Supply and Demand, China Pharmacy,1998,9 (5):198-201Hu Jinhong.

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