Objective: We designeda guideline for the use of in-line filters and infusion-tubing for infusion to improve the effectiveness and safety of infusion treatment in October 2016. The purpose of this study was to investigate the implication of the design and evaluation of usability of this guideline.
Design and Methods: We conducted a questionnaire survey regarding this guideline among pharmacists and nurses in our hospital between January and February 2018. In addition, we investigated the inquiries made to the division of drug information (DI) and the reports of incidents from 2008 to 2019 and extractedcontent regarding in-line filters. We counted the number of reports relatedto in line filters per year, the kindof drugs, and time taken to address inquiries, and comparedthese with every 3 years before this guideline was made public and 3 years after publishing this guideline.
Results: For “know” this guideline, the number of pharmacists was 40 (75%) and the number of nurses was 197 (57%). For “use” this guideline, the number of pharmacists was 29 (55%) and the number of nurses was 94 (27%). The average number of inquiries made to the division of DI was 4.7 for 2014-2016 and 1.7 for 2017-2019. The average number of reports of incidents was 8.3 for 2014-2016 and 6.0 for 2017-2019.
Conclusion: This guideline tended to decrease the number of inquiries made to the division of DI and reports of incidents. Therefore, we suggest that this guideline contributedto the mitigation of the work loadof the division of DI and the effectiveness and safety of infusion treatment.
Object: In this study, we conducted a fact-finding investigation to determine the reason for the gap between medical services provided by family pharmacists and the medical needs of patients, and examined factors that affect the rate of signing consent forms.
Methods: This study implemented an Internet questionnaire survey of patients who regularly use pharmacies owing to chronic diseases, and family pharmacists, surveying information on the services provided by family pharmacists.
Results: The survey extracted “inventory of leftover drugs”, “providing consultations outside pharmacy hours”, “introducing local medical/nursing facilities”, and “home visits”, as characteristic services that patients expected to be provided by family pharmacists. In addition, family pharmacists provided these four services at rates of 87.4, 75.9, 51.7 and 48.5%.
Conclusion: These results suggest a possible discrepancy between the functions of family pharmacies required by patients and the medical services provided by family pharmacists. Steps should be taken to match services provided by family pharmacists with the needs of the patients, to increase the rate of signing consent forms.
Objective: Therapeutic drug monitoring (TDM) analysis software is often used in clinical settings to estimate the dosage for vancomycin (VCM). In this study, the new TOWA-TDM analysis software was evaluated and compared with an existing analysis software based on predictability and Bayesian convergence.
Methods: The abilities of two TDM analysis software, TOWA-TDM ver.1.0.0 and “Vancomycin MEEK TDM analysis software ver. 3.2” (MEEK), were compared retrospectively. Twenty patients who received VCM therapy were randomly chosen, and clinical data were obtained from their medical records. The VCM trough concentrations were estimated from the clinical data and compared with the observed trough concentrations. Predictive performance was evaluated by calculating the mean prediction error (ME), mean absolute prediction error (MAE), and root mean square error (RMSE). Moreover, the pharmacokinetic parameters of each patient were estimated via Bayesian analysis using the observed trough level and then compared between the two software.
Results: In the initial dosage design of VCM using population pharmacokinetic (PPK) parameters, the predictability (MAE and RMSE) of the VCM trough levels showed no significant difference between the two software. However, the predicted trough values calculated using the TOWA-TDM were significantly lower than those calculated using MEEK. In Bayesian analysis, the estimated individual pharmacokinetic parameters differed between the software because of differences in the PPK equations and parameter restrictions employed; however, good convergence property to the observed trough values was shown by both the software.
Conclusions: This study indicates that TOWA-TDM has equivalent predictability and convergence (MAE and RMSE) with those of the existing software, MEEK, in the initial dosage design of VCM and Bayesian analysis. However, ME in the initial dosage design showed a significant difference between the two software owing to the difference in predicting renal function.
Objective: Missing high evidence-level articles during a literature search inhibits the use of information useful for research programs and reviews. Checking the core journals included in the search results serves as a guide to determining the search’s appropriateness. This study specifically researched core journals on peptic ulcer remedies to verify the quality of articles included therein.
Method: We searched for core journals on peptic ulcer remedies using Bradford’s law. To evaluate the quality of the articles included in the core journals, we examined the implementation rates of RCTs and the double-blind method.
Results: We were able to verify Bradford curves from the extracted articles. Each journal group approximated the theoretical values based on proportional expressions. 2,164 occurrences of omeprazole, 1,109 occurrences of ranitidine, and 917 occurrences of cimetidine were extracted from the database. Two of the core journals were about omeprazole, three about ranitidine, and five about cimetidine. All core journals were specialty journals on the digestive system, except for The Lancet. The implementation rates of RCT and double-blind method comparison tests for the core journals tended to be higher than other journal groups.
Conclusion: Quantitative processing of the clinical papers on each drug enabled us to identify appropriate core journals. Because the quality of this journal group tended to be higher than that of other groups, the search quality can be assured by checking the core journals included in search results.
Objective: Drug-device combinations (DDCs) are combinations of drugs and medical devices. Medical device faults associated with DDCs can cause health problems. Although it is important to collect and analyze information on medical device faults associated with DDCs, the awareness of DDCs and medical device fault reporting systems in pharmacists has not been reported. Accordingly, in this study, we aimed to investigate the degree of awareness of DDCs and the medical device fault reporting system for DDCs in pharmacists in Japan.
Methods: A postal questionnaire survey was conducted for 90 pharmacists working at hospitals and pharmacies in Chiyoda-ku, Tokyo, Japan between July and August 2020. The structured questionnaire consisted of questions regarding the work patterns of the pharmacists, their knowledge of DDCs, and their awareness of the device defect reporting system for DDCs.
Results: The response rate to the questionnaire was 51.5% (n = 46), and 70% of pharmacists were aware of DDCs. However, only approximately 20% of pharmacists were aware of the medical device fault reporting system for DDCs. Although 26.7% of pharmacists had experience with information support for medical device faults associated with DDCs from a pharmaceutical company and only approximately 20% had experience with the website of the Pharmaceutical and Medical Devices Agency (e.g., case reports of device defects for DDCs), most pharmacists (91.1%) considered information on medical device faults associated with DDCs to be important.
Conclusion: To enhance the spontaneous reporting of medical device faults associated with DDCs by pharmacists, it is necessary to ensure that pharmacists are aware of medical device fault reporting systems for DDCs.
Objective: The government is promoting generic drugs to increase their usage rate to 80% and thereby reduce medical costs. In October 2014, the usage share of generic drugs at the University of Miyazaki Hospital was 25.5%. Therefore, this study focuses on the spread of generic drugs by utilizing the medical supply, processing, and distribution (SPD) system.
Methods: The switch from the original drug to the generic drug was examined using the original simulation tool based on the information obtained from the medical SPD system. The drug cost reduction effect was calculated monthly, by multiplying the drug price difference between the generic and the original drugs by the amount used. The survey period was from October 2014 to July 2018.
Results: The share of generic drugs used reached 82.9% (cutoff value 50.8%) in October 2016, by switching from 278 original drugs. In July 2018, there was a switch from 315 original drugs and achieved 87.9% (cutoff value 56.5%) of generic drugs used. The cumulative total of drug cost reductions was JPY 235,670,518.
Conclusion: The monitoring and evaluation of generic drugs through the medical SPD system were useful for promoting generic drugs and thereby reducing drug costs.
Objective: The prescription-related inquiry process is being simplified in an increasing number of facilities, wherein doctors and pharmacists discuss ambiguous points concerning prescriptions before creating protocols. For making this process more efficient and further promoting appropriate drug use, the doctors and the Department of Pharmacy of our center discussed the permissible range for prescription change reports and determined the prescription items that pharmacists can change based on their own judgment. We analyzed data related to the simplification of the prescription-related inquiry process to verify the effects and issues associated with simplifying this process. Then, we examined the countermeasures that should be taken as a prescription issuer in response to the issue.
Methods: The center concluded an agreement with 147 insurance-covered pharmacies in or around Sakai City. We analyzed data related to simplification of the prescription-related process between March 1, 2017, and February 28, 2018.
Results: Permissible prescription change reports were classified into eight categories. The total number of out-of-hospital prescriptions issued by the center was 94,785. Among the 147 insurance-covered pharmacies under the agreement, 79 (53.7%) reported prescription changes by fax. In total, 895 prescription changes were reported. The number of reports belonging to each category was as follows: change of dosage/additional descriptions: 312 (33.1%); change to other brands with the same ingredients: 208 (22.0%); and change of the medication duration to reduce unused medications: 168 (17.8%). Calculating based on drug prices, change of the medication duration to reduce unused medications consequently reduced medication costs by 709,452 yen.
Conclusion: It is thought that the simplification of inquiry will result in shortening the waiting time for patients and reducing the time burden of prescribing doctors and pharmacists. Also, by analyzing the contents of the inquiries, it was evident that improvements could be made to improve efficiency by devising an electronic medical record system, which can help avoid similar reports in the future. Furthermore, regularly reviewing the simplifications will contribute to providing higher quality medical care. Cooperation and information sharing between pharmacy pharmacists and hospital pharmacists are indispensable and vital in advancing side effects and risk aversion, polypharmacy measures, and improvement of adherence.