摘要目的:建立标准化哺乳期用药咨询服务临床思维模式和决策路径，保障哺乳期妇女用药咨询服务的规范化。方法:对2020年6月至2022年8月北京大学第三医院临床药师为医务人员提供的哺乳期用药咨询服务情况进行回顾性统计分析和根因分析。应用混合方法建立哺乳期安全用药临床思维模式和哺乳期安全用药路径。对药师进行哺乳期用药咨询服务培训，培训前后进行问卷调查，对改进效果进行评价。结果:共收集到临床药师为医务人员提供的用药咨询服务1 218例，其中哺乳期用药相关案例44例（3.61%）。研究结果显示，临床药师在开展哺乳期用药咨询服务中存在对患者的需求了解不清晰，药物、母体及婴儿3个方面因素考量不全面，信息检索途径单一等问题。基于存在的问题进行根因分析，建立"提出问题（Q）、评估因素（A）、检索评价（S）和制定方案（P）"（QASP）的哺乳期安全用药临床思维模式，制定安全用药决策分析临床路径并形成标准的用药咨询记录模板。与培训前比较，临床药师在明确哺乳期用药相关因素、循证流程、规范记录和用药咨询自信心等方面均有显著提升（均 P<0.001）。 结论:哺乳期安全用药咨询服务的QASP临床思维模式和基于药物、母体及婴儿3个因素的决策分析模式的建立，有助于临床药师针对哺乳期特殊人群开展标准化用药咨询服务，提高同质化药学服务质量。

abstractsObjective: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.