When the hospital information system was updated in Toyonaka Municipal Hospital in January 2003, the dispensing support system, a subsystem of the existing hospital information system, was restructured. The new dispensing support system, which is able to save prescriptions in electronic media (Electronic Prescription Saving System), was developed to enhance patient safety. The Electronic Prescription Saving System has various safety management functions including those for preventing dispensing mistakes, dispensing investigation support, and collection of information on dispensing mistakes. The function for preventing dispensing mistakes incorporates a dispensing check system, which uses a Personal Digital Assistant (PDA) equipped with a wireless LAN facility and a bar code reader, and a medicine filling check system, which were specially developed for the prevention of mistakes. We are confident that the new dispensing support system will be useful in assuring patient safety and help tremendously in achieving our safety management goal of “zero errors” in the future.
The aim of this study was to devise a Drug Compliance Instruction Program (DCIP) for patients with type 2 diabetes taking oral hypoglycemic agents (OHA) and to assess its effectiveness. The new program was devised to improve levels of understanding and implementation in drug therapy for diabetes with the aims of contributing to and evaluating the effectiveness of such therapy. As its major features, the program uses the level of drug therapy implementation as an indicator of drug compliance and gives patients instructions on several occasions to ensure that they continue to be effective. Subjects were 109 type 2 diabetes outpatients who had HbA1c levels of 7% or more and were taking OHA. To study the effectiveness of the instructions, patients were randomly assigned to two groups : a single instruction group (n=66), and a multiple instruction group (n=43), whose subjects received instructions at least twice. DCIP significantly improved the levels of understanding (p=0.001) and implementation (p=0.033) of the drug therapy. The status of glycemic control based on HbA1c levels was used as an indicator in the evaluation of instructions, whose educational effect was significantly higher in the multiple instruction group than in the single instruction group (p=0.042). By enhancing levels of understanding and implementation in drug therapy for diabetes, DCIP significantly improved glycemic control, and this was maintained when instructions were given on several occasions.
Up till now, the major drug information-related activity of hospital pharmacists has been to disseminate drug safety information issued by the Ministry of Health, Labour and Welfare. However, another important activity of pharmacists is noting adverse drug reactions (ADR) occurring in their own hospital and informing other medical staff about them. This information should also be reported to the Ministry of Health, Labour and Welfare so that the adverse reactions may be widely known among the medical community. In order to investigate the extent that pharmacists actually conduct such activities, a questionnaire survey was sent to 62 national hospitals and the number of ADR reports to the Ministry of Health, Labour and Welfare from 189 national hospitals in fiscal 2003 was investigated. The results indicated that most hospitals were insufficiently aware of the ADRs that occurred. A major reason for this was considered to be the lack of systems for collecting and reporting adverse reactions. Pharmacists were found to be involved in 78% of ADR reports. For the National Cardiovascular Center, the survey showed that the introduction of an ADR collecting system in which pharmacists played a leading role had significantly increased the number of ADR reports to the Ministry of Health, Labour and Welfare. Moreover, 3% of the reported ADRs were related to safety information from the Ministry of Health, Labour and Welfare. The survey results also suggested that providing safety information to physicians is effective in improving safety in the use of drugs. Although medical staff were only aware of about 3% of the ADRs, the crucial role of pharmacists in collecting and reporting ADRs was recognized.
Methicillin-resistant Staphylococcus aureus (MRSA) is a gram-positive bacterium, and the treatment of patients with MRSA has induced microbial substitution. Regarding antibiotics used for treatment, vancomycin (VCM) has an antibacterial action only against gram-positive bacteria, while arbekacin (ABK) has an antibacterial action against both gram-positive and gram-negative bacteria. In view of this, we supposed that there would be a difference in gram-negative bacteria occurrence rates between patients administered VCM and those administered ABK and tested this supposition by comparing the appearance of gram-negative bacteria in these two patient groups. While gram-negative bacteria were newly detected in 45% of patients after receiving VCM, no patients receiving ABK showed any new gram-negative bacteria. On the other hand, gram-negative bacteria were still detected after administering ABK in patients who had gram-negative bacteria beforehand. This finding suggests that ABK may not be a superior agent when gram-negative bacteria are already present.
This report describes how good medication guidance may be provided to patients with blood cancer and discusses the role of the pharmacist in raising the satisfaction of patients and family members with treatment. Chemotherapy for blood cancer causes a variety of severe adverse reactions, giving patients and their families a feeling of anxiety towards it. It is therefore necessary for pharmacists to provide medication guidance in order to reduce anxiety towards drugs during long-term chemotherapy. In the present study, we examined questions regarding chemotherapy from patients and their families for 32 cases in the past 3 years. The 485 questions asked were classified according to subject as follows : 1) Adverse reactions-40%, 2) Chemotherapy protocol-12%, 3) Blood transfusions-7%, 4) Effects of chemotherapy-6%, 5) Granulocyte-colony stimulating factor (G-CSF) -6%, 6) Method of use-4%, 7) Drugs preventing opportunistic infections-4%, 8) Administration method-3%, 9) Chemotherapy in outpatient ward-3 %, 10) High-dose chemotherapy-3 %, 11) Discharge and short stay at home-1%, 12) Drop-out-1 %, 13) Drawing blood-1 %, 14) Color of chemotherapy agents for injection-1%, and 15) Differences between treatment strategies at other hospitals-1%.
To ensure that clinical trials are conducted in accordance with the new GCP guidelines, our pharmacists started acting as clinical research coordinators (CRC) in November, 1999. In the present study, we examined the CRC's support of the enrollment and withdrawal of patients for clinical trials. Between November, 1999 and April, 2003, a total of 138 patients had originally been enrolled for trials but on the basis of closer examination by CRCs, 31 of these patients (22.5%) were considered to be in contravention of the inclusion criteria. For 64.5 % of them (20/31), there were problems with drugs in their prescriptions from other hospitals or our own hospital, involving contraindicated drugs or drugs given to treat complications. Regarding withdrawal from trials, 28.6% (6/21 patients) stopped participating voluntarily suggesting that a large number of patients had feelings of anxiety concerning the effects of the new drugs and their adverse reactions. We felt that the efforts of CRCs in checking prescriptions for problem-causing drugs prior to obtaining patient consent to participate in trials and continuous follow-up of subjects during trials were very useful, and that pharmacists can make an important contribution to ensuring that clinical trials are conducted properly.
The Department of Pharmacy at Osaka Red Cross Hospital, a general hospital, accepts pharmaceutical trainees every year. However, as no one is specifically in charge of training, all of our staff undertake the task of teaching. In order to ensure that teaching is effective and thorough, we prepared a textbook for the trainees' practical training. We also conducted a questionnaire to ascertain how well they understood the various aspects of the training and how useful they thought the textbook was. Responses showed that trainees had a better understanding of almost all of the topics after receiving training in them. Topics for which understanding remained the same were those that had not been covered in introductory lectures at the trainees' universities, which were thus considered to be lacking in certain respects. The results of this questionnaire indicated that the preparation of good teaching plan is essential to ensuring that training is effective and of high quality. We also feel that is important to cooperate more closely with universities so that hospital training for pharmacists can be made even better.
In recent years, hospital infections due to bacterial species such as MRSA (methicillin-resistant Staphylococcus aurus) and VRE (vancomycin resistant Enterococcus), have become a social problem and there have been increases in the number of elderly people and compromised hosts having impaired immunity In consideration of this, we tested the sterilization effect of ETHACOTT®commercial alcohol-impregnated cotton swabs whose alcohol content is equivalent to ethanol for disinfection. It was very effective against non-clinical species of bacteria when itssterilization effect was comparable with 70% isopropanol. We therefore examined its antibacterial effectiveness under controlled conditions in order to determine the best way of using of ETHACOTT®. We also studied the effect of changing the ethanol concentration and cotton swab volume on sterilization capability using bacteria isolated in clinical practice at Hirosaki University Hospital. In bacteriological analysis, we found that for optimum effect, the swabs should be used within 5 days, noting decreased antibacterial effectiveness after seven days when in the package and after 3 hours when left in an open jar. The effectiveness of ETHACOTT® was observed to vary with the bacterial species, being particularly ineffective against MRSA and VRE. We will report these results to the infection control center of Hirosaki University Hospital in order to establish standard guidelines for use of ETHACOTT®.