中国临床药学杂志

目的 建立并应用达拉非尼联合曲美替尼治疗用药管理路径，为临床药师开展药学监护提供新思路。方法 临床药师根据接受达拉非尼、曲美替尼联合治疗的黑色素瘤患者用药随访结果，分析患者用药问题产生的原因。依据分析结果，参照临床路径设计思路建立达拉非尼联合曲美替尼治疗用药管理路径并实施管理，对用药管理路径实施前后药师的用药宣教质量、用药问题发生率和主动药学评估咨询比例等进行了对比。结果 路径管理前共随访50例患者，其中46%的患者存在用药问题，包括用法用量、不良反应处置和药物相互作用等多个方面。基于对路径管理前用药问题产生原因的分析，建立了覆盖患者居家用药全程的用药管理路径。47例患者接受了用药管理路径的干预。与路径管理前比较，实施路径管理后用药宣教质量显著提高，用药错误发生率显著降低，用法用量错误发生率降低（24.0%vs 4.3%），发热处置错误率降低（43.0%vs 0），差异有统计学意义（P <0.05）。无患者存在合并用药问题或药品保存问题。且首次出现发热后主动寻求药师帮助的比例显著增加（6.6%vs 91.7%），主动进行用药咨询和评估的人次显著提高（13人次vs 43人次）。结论 通过建立针对达拉非尼联合曲美替尼治疗的用药管理路径可减少临床用药错误，促进药师–患者间的沟通，提高药师管理质量，帮助临床药师实现规范化、高质量的管理。

AIM To establish and implement a medication management pathway for dabrafenib plus trametinib combination therapy, and provide a new pharmaceutical care mode for clinical pharmacists. METHODS Clinical pharmacists analyzed the causes of medication errors during the follow-up of melanoma patients receiving dabrafenib plus trametinib combination therapy in our hospital. Then a medication management pathway in dabrafenib plus trametinib combination therapy was established according to data analysis and implemented. Quality of patient education, the occurrence of medication errors, and proactive medication assessment consultation rate were compared before and after the implementation of the medication pathway. RESULTS A total of 50 patients were followed up before pathway management, with 46% of the patients experiencing medication errors, including medication usage errors, adverse drug reaction management errors, and drug interactions, etc. Based on the analysis of the causes of these medication errors, a medication management pathway covering the whole course of home medication was established.Tolly 47 patients received interventions by clinical pharmacists following the proposed medication management pathway. Following the implementation of pathway management, the quality of patient education was significantly improved. The incidence of medication errors was significantly reduced. The frequency of medication usage and dosage errors decreased( 24.0% vs 4.3%), and the frequency of inappropriate fever management decreased significantly(43.0%vs 0), both with a statistically significant difference(P < 0.05). In addition, no patients had potential drug interaction issues or medication storage problems. There was a significant increase in the proportion of patients actively seeking drug consultation after the first presentation of fever( 6.6% vs 91.7%). The number of proactive drug consultations was also considerably increased(13 vs 43). CONCLUSION The establishment of medication path management for dabrafenib combined with trametinib treatment can reduce clinical medication errors, promote the communication between pharmacists and patients, improve the quality of pharmacist management, and help clinical pharmacists achieve standardized and high-quality management.