Objective:To explore the importance and the breakthrough points of pharmaceutical care for patients with renal disease,especially using drugs with narrow therapeutic window and notable individual difference.Methods:Digoxin concentration and international normalized ratio (INR) were detected by clinical pharmacists,and then individualized pharmaceutical care was given to the patient according to the monitoring results.Results:Physician increased the monitoring frequency and adjusted the drug usage according to the patient's renal function.The patient's condition was improved and understood the necessity of related index monitoring.Conclusion:Clinical pharmacists can assist physicians in optimizing the treatment,and ensure safe,reasonable and effective medication by providing pharmaceutical care in various aspects.

OBJECTIVE:To explore the ideas for the prescription comment of TCM injections,and provide reference for clini-cal rational use. METHODS:Totally 9 457 prescriptions in PIVAS and 400 hospitalized medical records in our hospital in 2015 were collected. The prescriptions and hospitalized medical records which contained TCM injections were retrospectively commented in aspects of indications,usage and dosage,drug combination,solvent selection and repeat medication,and analysis of typical case. RESULTS:In 2015,there were 2 544 prescriptions(26.90%)in PIVAS and 195 medical records(48.75%)that used TCM injections;the irrational use was mainly inappropriate solvent selection(50.70%),inappropriate usage and dosage(27.00%),inap-propriate indications (10.33%),inappropriate combination therapy (7.51%) and repeat medication (4.46%). CONCLUSIONS:Prescription of TCM injections should be commented with the medical records and individual analyzed;in terms of unreasonable prescriptions and medical records TCM clinical pharmacists should actively intervene unreasonable prescriptions by the bed.

Standardized and refined training model of the clinical pharmacist plays an important role in improving the pharmacy service.The authors summarized the experience and the training model of clinical pharmacists in the respiratory department.Standardized teaching methods and work path were built.Clear training goals were set up.The training model based on clinical practice enhanced the clinical pharmacists' ability of communication with physicians and patients.The basic knowledge,the clinical thinking and learning ability of the clinical pharmacist were strengthened,which inspired their learning enthusiasm and improved their ability of resolving clinical problem with appropriate medication therapy.So that we could set up a perfect,matured and professional training model