外科药学：FIP的全球视角-国际药学联合会（FIP）主席Paul Sinclair AM在第三届外科药学大会的讲话

Surgical pharmacy: A global perspective from FIP

外科药学：FIP的全球视角

Hello, I’m Paul Sinclair, president of the International Pharmaceutical Federation — FIP. I’d like to thank the FIP China Envoy Chen Zheng-Yu and the China (GuangDong) Pharmaceutical Association for inviting me to give a global perspective on the topic of surgical pharmacy, the diverse roles of pharmacists and the importance of our profession.

大家好，我是Paul Sinclair，国际药学联合会（FIP）主席。感谢FIP中国特使陈征宇先生和中国（广东省）药学会邀请我就外科药学的主题、药师的不同角色，以及我们这个职业的重要性发表全球视角的演讲。

FIP is the global body for pharmacy, pharmaceutical sciences and pharmaceutical education. Through 153 national organisations, allied organisations (including academic institutional members) and individual members, we represent over four million pharmacists, pharmaceutical scientists and pharmaceutical educators around the world. Our vision is a world where everyone benefits from access to safe, effective, quality and affordable medicines and health technologies, as well as from pharmaceutical care services provided by pharmacists, in collaboration with other healthcare professionals. Our mission is to support global health by enabling the advancement of pharmaceutical practice, sciences and education.

FIP是药学、药物科学和药学教育的全球性机构。通过153个国家组织、联盟组织（包括学术机构成员）和个人会员，我们代表了世界各地400多万药师、制药科学家和药学教育工作者。我们的愿景是建立一个人人都能获得安全、有效、优质和可负担的药品和卫生技术，以及药师与其他医务人员合作提供的药学服务的世界。我们的使命是通过促进药学实践、科学和教育的进步来支持全球健康。

FIP believes that many health outcomes, including surgical outcomes, can be enhanced through pharmacist interventions.

FIP认为，许多治疗结局，包括外科治疗结局，可以通过药师的干预得到改善。

•      Pharmacists play a crucial role in post-operative care, focusing on antibacterial treatment prophylaxis.

•      药师在术后监护中起着至关重要的作用，重点是预防感染。

•      Audit data reveals non-compliance with guidelines regarding the duration of parenteral treatment and the prolonged duration of prophylactic therapy.

•      处方审核数据显示，不遵守指南规定的肠外治疗用药时间以及延长预防治疗时间的情况较为常见。

•      Highlighting the need for a switch from parenteral to oral use in a timely manner to prevent prolonged therapy durations.

•      强调需要及时从肠外转向口服，以防止治疗时间的延长。

•      In surgery and obstetrics/gynaecology settings, medical teams have recognised the value of having pharmacists oversee medication protocols as a step toward enhanced antimicrobial stewardship.

•      在外科和产科/妇科，医疗团队已经认识到药师监管用药方案的作用，这是加强抗菌药物管理的重要一步。

Pharmacists can make a particular contribution in cardiology.

药师可以在心脏病治疗方面做出特殊的贡献。

•      As cardiology moves from conventional surgery to more interventional approaches using robotics and medical devices, pharmacists' roles have evolved.

•      随着心脏病治疗从传统的外科手术转向更具介入性的方法，如使用机器人技术和医疗器械，药师的角色也发生了变化。

•      Pharmacists ensure personalised and optimised medication therapy post-intervention, especially in acute settings, to avoid hypotensive crises.

•      药师确保干预后的个体化药物治疗，特别是在严重情况下，避免低血压危象。

•      In chronic treatment plans, the focus is on achieving manageable blood pressure targets, tailoring heart failure treatment based on patient outcomes (rather than strictly following guidelines), and adjusting to high-intensity statin therapy as needed based on lipid profile monitoring.

•      在长期治疗计划中，重点是实现可控制的血压目标，根据患者情况（而不是严格遵循指南）调整心衰的治疗，并根据血脂监测结果调整高强度他汀类药物治疗。

The evolving role of pharmacists includes leading antimicrobial stewardship programmes to combat resistance and improve patient outcomes.

药师作用不断发展，包括主导抗微生物药的管理，以对抗耐药性和改善患者预后。

•         Innovative strategies for antimicrobial stewardship have been developed, including real-time monitoring and decision support systems that guide optimal antibiotic selection and duration.

•         最新的抗微生物药管理策略已被制定，包括指导抗菌素的选择和治疗期间的实时监测和决策支持系统。

•         Collaboration with surgical teams to implement evidence-based protocols for antibiotic prophylaxis, reducing unnecessary antibiotic use while ensuring effective infection prevention.

•         与外科团队合作，实施循证的抗生素预防方案，减少不必要的抗生素使用，同时确保有效预防感染。

Technology is playing an important part in enhancing surgical pharmacy practice.

相关技术在提高外科药学实践水平方面发挥着重要作用。

•         The integration of technology, such as robotic dispensing systems and electronic health records (EHRs), enhances the efficiency and accuracy of pharmacists' work in surgical settings.

•         技术的集成，如机器人配药系统和电子健康记录（EHRs），提高了外科药师工作的效率和准确性。

•         Pharmacists utilise advanced software for medication therapy management in surgical patients, allowing for personalised medication plans based on patient-specific data and surgery type.

•         药师利用先进的软件对手术患者进行药物治疗管理，基于患者特定数据和手术类型实施个体化的用药方案。

•         Wearable devices for post-surgical patients enable remote monitoring of vital signs and medication adherence, empowering pharmacists to proactively adjust treatments in response to real-time data.

•         术后患者的可穿戴设备可远程监测患者生命体征和用药依从性，使药师能够根据实时数据主动调整治疗方案。

The future envisions pharmacists as integral members of the multidisciplinary surgical care team, involved from pre-operative assessment to post-operative care and rehabilitation.

药师将成为多学科外科治疗团队不可或缺的一员，参与从术前评估到术后监护和康复。

Focus on patient education and empowerment, ensuring patients understand their medication regimens, potential side effects, and the importance of adherence for optimal recovery.

关注对患者的教育和授权，确保他们了解药物治疗方案、潜在的副作用，以及用药依从性对康复的重要性。

Research and innovation in surgical pharmacy practice continue to push the boundaries, with pharmacists leading and participating in clinical trials to develop and evaluate new pharmacological interventions in surgical care.

外科药学实践的研究和创新不断取得突破，药师主导和参与临床试验，以开发和评估外科治疗中新的药物干预措施。

FIP has a number of resources to support surgical and clinical pharmacy practice.

FIP有许多资源来支持外科和临床药学实践。

I‘d like to share with all of you some examples of how far clinical pharmacy has come.

我想和你们分享一些例子，说明临床药学的发展状况。

•      In 1990, Hepler and Strand shared their concept of pharmaceutical care. This can be defined as ‘the responsible provision of drug therapy (by pharmacists) for the purpose of achieving definite outcomes that improve a patient’s quality of life’. Within this, Strand and Hepler included all aspects of disease and symptom prevention and treatment, together with identifying and either preventing or resolving potential and actual drug-related problems.

•      1990年，Hepler和Strand分享了他们的药学监护概念，定义为“负责任地提供药物治疗（由药师），以达到改善患者生活质量的明确结局”。该工作涵盖了疾病和症状的预防和治疗的各个方面，以及识别和预防或解决潜在和存在的用药相关问题。

•      Since 2006 the pharmacy degree course in Japan has required 6 years of university education, of which six months is spent in hospital and community placements. These changes were, in part, instituted to open the way to closer pharmacist involvement in medicines selection and use. So far, hospital pharmacy practice in Japan has generally been slower to develop clinical care services compared to community services.

•      自2006年以来，日本的药学学位课程要求6年的大学教育，其中6个月在医院和社区实习。在某种程度上，这些改变是为了使药师更密切地参与药物的选择和使用。迄今为止，与社区服务相比，日本医院药房的临床监护服务发展普遍较慢。

•      In Sweden, Australia and France, interventions such as the establishment of antibiotic use surveillance systems, linked to changes in prescribing and dispensing incentives and controls, have already been introduced to help ensure more optimal drug use.

•      在瑞典、澳大利亚和法国，已经引入了诸如建立抗菌素使用监测系统等干预措施，并与处方和配药激励和控制措施关联，以确保药物的合理使用。

•      In secondary care, the UK Department of Health provided short-term funding in 2003 to establish antimicrobial pharmacists. Their role was to collaborate across teams and networks to integrate antimicrobial stewardship into hospital infection control practice.

•      在二级医疗方面，英国卫生部于2003年提供了短期资金设立抗微生物药师。他们的作用是跨团队、跨部门合作，将抗菌药管理纳入医院感染控制工作。

•      UK hospital pharmacists have been instrumental in reducing prescribing of high-risk broad-spectrum medicines (notably cephalosporins and fluoroquinolones) associated with Clostridium difficile infection and coinciding with a reduction in C. difficile infections and stabilisation in resistance to these antimicrobial agents.

•      英国的医院药师在减少治疗艰难梭菌感染的高风险广谱药物（特别是头孢菌素和氟喹诺酮类药物）的处方上发挥了重要作用，同时也减少了艰难梭菌感染，并稳定了艰难梭菌对这些抗菌药的耐药性。

•      In the UK, a smartphone application for antimicrobial guidelines (MicroGuide) was developed by pharmacists and medical microbiologists and has been licensed to over 45 hospitals. The app content can be edited by clients according to local resistance patterns and clinician preferences. In February 2015, MicroGuide was awarded the NHS Innovation Challenge Prize in the Infection Control category. Another smartphone application “IAPP” was found to have a positive effect on antimicrobial prescribing in hospitals in both medicine and surgery.

•      在英国，药师和医学微生物学家开发了一款指导抗菌的智能手机应用程序（MicroGuide），并已在超过45家医院获得许可。客户可以根据当地的耐药模式和临床医生的偏好编辑应用程序内容。2015年2月，MicroGuide获得了感染控制类NHS创新挑战奖。另一款智能手机应用“IAPP”对医院的内科和外科抗菌药物处方产生了积极影响。

•      The American Society of Health-System Pharmacists published the 2019 update from the Pharmacy Accountability Measures Working Group regarding quality measures that health-system pharmacists can implement to ensure patient safety. This update included measures such as INR monitoring for patients taking warfarin, undergoing venous thromboembolism prophylaxis in the intensive care unit, taking medicines for glycaemic control or using opioids.

•      美国卫生系统药师学会发布了2019年更新的药房问责措施工作组关于卫生系统药师为确保患者安全可实施的质量措施。这一更新包括对服用华法林、在重症监护病房接受静脉血栓栓塞预防、服用血糖控制药物或使用阿片类药物的患者进行INR监测等措施。

•      In Canada, hospital pharmacists are often medication experts in therapeutic areas such as internal medicine, obstetrics, oncology and infectious disease management. Pharmacists interpret laboratory values, are involved with antimicrobial stewardship, and act as mentors, collaborators and scholars. Pharmacists are also often involved into interprofessional committees such as drugs and therapeutics, medication safety and different quality improvement initiatives.

•      在加拿大，医院药师通常是内科、产科、肿瘤学和传染病管理等治疗领域的用药专家。药师解读检验数据，参与抗菌药管理，并成为团队中的导师、合作者和学者。药师也经常参加跨专业的委员会，如药物和治疗学委员会、用药安全委员会以及各种质量改进委员会。

Pharmacists’ clinical role has grown, and the specialty of surgical pharmacy is a great example of further development. At the end of 2015, the GuangDong Pharmaceutical Association (GDPA) in China proposed the concept of a “surgical pharmacist”. In September 2018, the GDPA worked on creating surgical pharmacist positions in hospitals and defined their responsibilities as taking care of the whole process of medication management during the perioperative period and beyond. This involves focusing on perioperative medication, such as anti-infection, anti-thrombosis and analgesia medicines, as well as on clinical nutrition, blood glucose, blood pressure, liquids management, the treatment of postoperative nausea and vomiting, the use of glucocorticoids, controlled drugs management, medication reconciliation and deprescribing. A further responsibility is the management of drugs prone to be used irrationally, such as proton pump inhibitors, and medication beyond the perioperative period but related to the procedures, such as immunosuppressant use for transplantation patients, and antithrombotic drug use after stent implantation. Pre-, mid-, and post-operative medication therapy management services for perioperative patients are at the crux of the surgical pharmacy specialty. FIP was pleased to hear that most surgeons were delighted to delegate medicines management authority to pharmacists, and that many large hospitals in GuangDong province now have established surgical pharmacist positions. The establishment of the specialty of surgical pharmacy was an important step for the GDPA to promote the extension of pharmacy services in China, and we thank our colleagues for sharing this significant achievement. FIP is very happy to support the sharing of this great development.

药师的临床作用日益增强，外科药学学科的出现是药师作用进一步发展的一个很好的例子。2015年底，中国广东省药学会提出了“外科药师”的概念。2018年9月，广东省药学会开展了在医院设立外科药师岗位的工作，并将其职责定义为负责围手术期及以后的全流程用药管理。这包括关注围手术期药物治疗，如抗感染、抗血栓和镇痛用药，以及临床营养、血糖、血压、液体管理、术后恶心和呕吐的治疗、糖皮质激素的使用、受控药物的管理、药物重整和处方精简。进一步的职责是管理容易不合理使用的药物，如质子泵抑制剂，以及超出围手术期但与手术相关的药物，如移植患者使用免疫抑制剂，以及支架植入术后使用抗血栓药物。围手术期患者术前、术中、术后的药物治疗管理服务是外科药学学科的核心。FIP很高兴地得知，大多数外科医生都愿意将用药管理权限赋予药师，广东省的许多大医院现在都设立了外科药师岗位。外科药学学科的建立是广东省药学会推动药学服务在中国延伸的重要一步，我们感谢我们的同事分享这一重大成就。FIP非常乐意支持分享这一伟大的发展。

Forward with pharmacy, forward with FIP.

药学不断发展，FIP不断向前！



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