Clinical Practice and Teaching of Pharmaceutical Care Procedures for Obstetric Diseases Xianli Wang, Yanyu Pang, Mengmeng Wang, Jin Jing, Jing Tang
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Original research Eur J Hosp Pharm: first published as 10.1136/ejhpharm-2019-002053 on 31 May 2020. Downloaded from Clinical practice and teaching of pharmaceutical care procedures for obstetric diseases Xianli Wang, Yanyu Pang, Mengmeng Wang, Jin Jing, Jing Tang Department of Pharmacy, The ABSTRact INTRODUCTION Obstetrics and Gynecology Objectives Our goal was to explore the pharmaceutical Current state of pharmaceutical care in China Hospital of Fudan University, Shanghai, China service and teaching methods of obstetric clinical Pharmaceutical care has become a hot topic in the pharmacists to establish standardised pharmaceutical field of hospital pharmacy in China in recent years, Correspondence to care procedures for obstetric diseases. and it is a new working model of hospital phar- Mrs Jing Tang, Shanghai, Methods According to the evidence- based medicine macy.1 Pharmaceutical care requires pharmacist China; angel_ tj99@ 126. com method, the “Standard of Pharmaceutical Care” was services to be “patient-centred” to detect poten- established to standardise the procedure and content tial clinical or actual medication problems through Received 1 August 2019 Revised 11 February 2020 of the pharmaceutical care procedure including custody, to assist in clinical prevention of potential Accepted 17 February 2020 preface, purpose, scope of application, responsibilities, medication problems, to resolve issues with inap- procedures, references, and appendix, with seven parts propriate medications that have been prescribed, EAHP Statement 4: Clinical 2 Pharmacy Services. in total. The object of the pharmaceutical care procedure and to ultimately improve patient outcomes. was selected by the harmfulness of the disease and Traditionally, the job of the Chinese hospital the drugs used. The clinical pharmacists in obstetrics pharmacist is to ensure the supply and dispensing formulated the pharmaceutical care procedure for each of drugs. With the reform of hospital pharmacy disease according to the standard and carried out clinical work in China, pharmacists who “focus on drug practice and teaching. dispensing” gradually changed to the clinical phar- A retrospective study was conducted to investigate the macists who “provide the services of clinical drug impact of the pharmaceutical care procedure before treatment”,3 which requires pharmacists to provide and after its implementation on both clinical practice pharmaceutical care for patients, such as pharma- and training. Obstetric pharmaceutical consultation ceutical ward rounding, optimising drug treatment and adverse reaction were the key indicators for clinical programmes, drug education, and adverse drug practice. reaction reporting. However, the pharmacists who The graduation assessment for students was strictly dispense medicines have insufficient experience in carried out in accordance with the regulations of the drug therapy and the level of pharmacy service is Chinese Hospital Association Pharmaceutical Affairs uneven in China. Professional Committee including communication and Due to the late start and slow development of clin- consultation capacity interview, case assessment, and ical pharmacy services and teaching in China, there is training procedure assessment. no standard pharmaceutical care procedure or stan- http://ejhp.bmj.com/ Results We established the standards for the dardised teaching protocol for clinical pharmacists. pharmaceutical care procedures for three diseases: Differences in the background of a clinical pharma- pregnancy with diabetes; pregnancy with thyroid cist’s professional, pharmaceutical service experience, disease; and pregnancy with hypertensive disorder. The and education will lead to differences in medication clinical pharmacist conducted the pharmaceutical care advice and medication education provided by medical procedure, participated in drug treatment management, care, potentially putting patients at risk. Therefore, and improved the recognition of the role of clinical there is an urgent need for the establishment of stan- pharmacists by the obstetric clinicians, often inviting the dard pharmaceutical care procedures to improve and on September 30, 2021 by guest. Protected copyright. clinical pharmacists to participate in the consultations. standardise pharmaceutical services. The clinical pharmacists discovered and addressed any adverse reactions in a timely manner through patient drug education, subsequently reducing the The challenges brought by the family planning underreporting of adverse reactions and improving policy with Chinese characteristics to clinical the patient’s medication compliance, which aimed to pharmacists in obstetrics improve the medical quality of patients in our hospital. In 1979, the one- child policy was introduced by the Second, the use of the pharmaceutical care procedure Chinese government. The negative consequences © European Association of as a teaching tool helped to train students to grasp the of the one- child policy are becoming increasingly Hospital Pharmacists 2020. key points of drug treatment and care of the disease obvious, including accelerating population ageing, Re- use permitted under CC and improve the students’ scores in the graduation the skewed sex ratio, and the decline in the work- BY- NC. No commercial re- use. Published by BMJ. assessment (P<0.05). ing- age population, which would threaten economic Conclusions As a pharmacy service and teaching growth. By 2007, the Chinese government started To cite: Wang X, Pang Y, method that can be promoted and implemented, the to permit couples who were both only-children to Wang M, et al. have two children. In November, 2013, a policy Eur J Hosp Pharm Epub pharmaceutical care procedure is beneficial for clinical ahead of print: [please pharmacists to carry out in- depth pharmaceutical allowing couples in which at least one of the marital include Day Month Year]. services and can also be used as a teaching tool for partners was an only child to have two children was doi:10.1136/ clinical pharmacist training. introduced. In October, 2015, China’s one- child ejhpharm-2019-002053 policy was replaced by a universal two- child policy. Wang X, et al. Eur J Hosp Pharm 2020;0:1–5. doi:10.1136/ejhpharm-2019-002053 1 Original research Eur J Hosp Pharm: first published as 10.1136/ejhpharm-2019-002053 on 31 May 2020. Downloaded from The new policy will allow almost all Chinese people to have Patients should be assessed again if their condition or medication their preferred number of children.4 regimen changes during hospitalisation. With the adjustment of the family planning policy, the proportion of elderly mothers in China is increasing, and the Optimisation of drug treatment plan chance of high-risk pregnancy, pregnancy complications, and The pharmacist should refer to the results of the pharmaceutical comorbidities is significantly higher in this population. For evaluation and actively communicate with the clinician to help example, the incidence of hypertensive disorder in pregnancy optimise the drug treatment plan. increases 3- fold, and the incidence of gestational diabetes 5 increases by 5.5- fold. As medication for pregnant women Develop and implement a pharmaceutical care plan is also related to the health of the child, it is necessary for The pharmacist should integrate the profile of the patient's clinical pharmacists to play a role in determining which drugs disease and medication to develop an individualised care to use and when. Fudan University Obstetrics and Gynae- programme and record the care results. cology Hospital (hereinafter referred to as “our hospital”) is a well- known domestic obstetrics and gynaecology specialised hospital. From 2011 to 2014, the number of perinatal outpa- Determination of pharmaceutical care indicators tient visits in our hospital increased from 144 923 to 1 83 339, In the course of care, the patient's treatment effect and adverse and the number of obstetric births increased from 12 636 to drug reactions are judged. When the drug treatment plan changes, 16 743. the clinical pharmacist timely adjusts the contents of the pharma- Pregnant women are in urgent need of clinical pharmacists ceutical care programme, including the efficacy and adverse reac- to provide them with quality pharmaceutical care. Thus, the tion care. purpose of this study is to establish the pharmaceutical care process for clinical pharmacists in obstetrics and to investigate Conduct medication guidance the application of the pharmaceutical care process in clinical According to the patient's medication situation, the reasons pharmaceutical care practice and teaching. for the treatment, the usage and dosage, the common adverse reactions and disposal measures, and the precautions for medi- cation, the pharmacist should intervene in improper drug use METHODS behaviour, answer the drug- related consultation questions, Standards for the establishment of pharmaceutical care and have the mission record signed by the patient or her procedures family. The pharmacist should also teach the patients before Combined with evidence- based medicine and clinical pathway discharging them from the hospital concerning the following methods,6 7 we established a standard pharmaceutical care topics including exercise, diet and medication, at least procedure to regulate the formulation procedure and specify including drug use and preservation methods, post- discharge the main content of the pharmaceutical care procedure, follow- up indicators, and follow-up plans. including