Exploration and establishment of clinical thinking model and decision-making pathway for medication consultation service during lactation
10.3760/cma.j.cn114015-20230202-00050
- VernacularTitle:哺乳期用药咨询服务临床思维模式和决策路径的探索与建立
- Author:
Huibo LI
1
;
Zhe ZHAO
;
Canyu YANG
;
Yinchu CHENG
;
Fang LIU
;
Yizhun ZHU
;
Jie LU
;
Yuan WEI
;
Tongyan HAN
;
Rongsheng ZHAO
Author Information
1. 北京大学第三医院药剂科，北京 100191
- Publication Type:Journal Article
- Keywords:
Medication use in lactation;
Medication consultation;
Mixed method;
Clinical thinking mode;
Clinical decision pathway
- From:
Adverse Drug Reactions Journal
2023;25(11):669-675
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore and establish a standardized clinical thinking mode and decision-making pathway for lactation medication consultation services and ensure the harmonization and safety of medication for lactating women.Methods:Lactation medication consultation services for medical staffs conducted by pharmacists from June 2020 to August 2022 in Peking University Third Hospital were analyzed using methods of retrospective statistical analysis and root cause analysis. Application of mixed methods were used to establish a clinical thinking model for medication use during lactation and a clinical pathway for safe medication use during lactation. Lactation medication consultation service training for pharmacists was provided, questionnaire surveys before and after the training were conducted, and the effectiveness of improvement was evaluated.Results:A total of 1 218 medication consultation services provided by clinical pharmacists to medical staffs were collected in the hospital, including 44 cases (3.61%) related to lactation medication. Retrospective analysis showed that clinical pharmacists did not have a clear understanding of patients′ needs, incomplete consideration of drug-maternal-infant factors, and a limited way to retrieve information in the lactation medication consultation service. Based on the root cause analysis of the problems, a clinical thinking mode of "Questions (Q), Assessment (A), Search (S), and Plan (P)" (QASP) were established. Additionally, a clinical pathway for safe medication decision-making analysis and a standard medication consultation record template was developed. Compared with before training, clinical pharmacists made significant progress in clarifying factors related to lactation medication, evidence-based procedure, standardized documentation, and confidence in providing medication consulations (all P<0.001). Conclusion:The establishment of the QASP clinical thinking model and decision analysis model, based on the 3 factors of medication, mother, and baby for the consultation service of safe medication during lactation, can help clinical pharmacists carry out standardized medication consultation services for breast-feeding populations during lactation, and improve the quality of homogeneous pharmaceutical services.
