The adsorption of insulin onto administration sets during its infusion has been reported in many studies.In glucose insulin (GI) therapy for newborn infants in particular,the degree of adsorption is important because the insulin dose is very low.Since this issue had not been clarified,we studied insulin adsorption in this case and examined methods for its prevention. We prepared an insulin fluid with 5% glucose solution (0.02 U/mL) and determined the residual amount of insulin in the fluid with time using an HPLC-UV system after flushing infusion sets for newborn infants with the fluid using a syringe pump.The syringe was made of polypropylene (PP) and the lines of polyvinyl chloride (PVC),polyethylene (PE) or polybutadiene (PB).For the in-line filter,we used posidyne® (PD),an electrically charged nylon 66 membrane.The residual amount of insulin for each type of line decreased to about 20 to 30% of the theoretical value immediately after starting the infusion and gradually increased to about 50 to 60% after 2 hr and then stayed constant.When the PD filter was used with the infusion sets,the residual amount of insulin decreased to below 10% immediately after starting the infusion and had not changed 8 hr later. The actual dose decreased to about 40% for each type of line,and to under 10% when the filter was used.To prevent adsorption,we added a total-vitamin injection containing the nonionic surface-active agent (Tween 80) to the insulin fluid (final concentration : 25μg/mL).The residual amount of insulin recovered to about 100% for the PB line but there was no change when the filter was used as well. In conclusion,our results show that the adsorption of insulin is a critical issue in GI therapy for newborn infants.
In order to ensure the appropriateness of courses in the 6-year Pharmacy Education Program,we conducted a patient communication training program for 302 third-year undergraduates taking the old 4-year Pharmacy Education Program at Kobe Pharmaceutical University in 2007.The aims of the program were (1)to learn how to provide patient-centered guidance on taking medicines and (2)to learn what is expected of the professional pharmacist.In the program,we divided students into small groups,each tutored by a professional pharmacist. To evaluate the effectiveness of the training,we assessed the knowledge of students and their impression of the occupation of pharmacist before and after the training.The results showed that there had been an improvement in the students’basic communication skills after the training.There were also improvements in students’abilities to obtain information from patients and to provide them with information. Though understanding of the professional role of the pharmacist still seemed to be lacking,students had a more concrete image of pharmacy as an occupation after the training. In conclusion,the participation of professional pharmacists in the training was useful not only as regards giving students a good idea of the occupation of pharmacist but also in letting them see how knowledge of pharmacy given in lectures can be used in practice in medical situations.However,certain issues need to be addressed,among them how to secure the continuous participation of professional pharmacists and maintain the quality of training.
The clinical pharmacy services provided by the satellite pharmacy to our hematological tumor unit include the mixing of injection drugs,making inquiries concerning injection drug prescriptions on the basis of medication history management and checking chemotherapy regimens.We investigated whether such services were useful in enhancing medical safety through a questionnaire survey of nurses in the hematological tumor unit.The results showed that the injection drug mixing service provided by pharmacists reduced the time that nurses took to mix injections by 50% as compared with before the service was introduced.Further,after the satellite pharmacy opened,the number of pharmacist inquiries addressed to physicians concerning doubtful prescriptions increased markedly,and the percentage of prescriptions which were changed due to doubtful content also increased greatly.As a result,the frequency of errors in medications decreased significantly.The findings of this study showed that clinical pharmacy services provided to the hematological tumor unit contributed to improving medical safety.
TS-1 is an oral anticancer agent used for a variety of cancers.In the clinical setting,many patients take TS-1 concomitantly with intravenous anticancer agents in several different regimens.In November,2006,we started giving consultation to outpatients taking TS-1 and undergoing chemotherapy concomitantly and providing continuous pharmaceutical care to enhance safety in their treatment. We made a consultation sheet for each patient and managed the administration schedule using a TS-1 check sheet and stickers for patient notebooks,which were used on each visit.From November,2006 to April,2007,we provided 482 consultations to 85 patients taking TS-1.As a result of pharmacists checking administration schedules and compliance at every visit to the outpatient oncology unit,no errors were made in the administration period of TS-1 for any patient.Pharmacists advised patients not only concerning administration schedules and dosages of TS-1,but also about opium and other concomitantly administered medications. The creation of the TS-1 check sheet has enabled pharmaceutical consultation to be standardized so every pharmacist can offer similar pharmaceutical consultation to each patient.Two-hundred-and-thirty-eight questions asked concerned anticancer agents (42%),medications other than anticancer agents (41%),opium (9%),and others (8%).Also,in 93 instances,pharmacists asked doctors to prescribe medications to prevent or reduce adverse effects that patients complained of and 96.8 % of such requests were reflected in prescriptions. In conclusion,it is effective for pharmacists to provide continuous consultation to patients who are taking TS-1 and visiting the Outpatient Oncology Unit,and such consultation enables patients to participate in ensuring that their outpatient chemotherapy is both safe and effective.
We have introduced a communication training program using problem-based learning (PBL) and simulated patients (SP) as a new teaching approach for pharmacy students.The communication training consisted of 5 processes involving 3 clinical scenarios that we designed (patient #1 : smoking cessation instruction,patient #2 ; taking anamnesis in pharmacy,patient #3 ; explanation of over-the-counter drug including health consultation).For smoking cessation instruction,first,the students were given the scenario and discussed how to solve the problems in small groups (process 1,2 and 3).They then shared the information collected by each group and prepared an instruction sheet for role-playing (process 4 and 5).In the roleplaying,students played the part of the pharmacist and received feedback from SP. Afterwards,we conducted a questionnaire survey of the students’impressions of the training using the Learning Management System and subjected the results to CS analysis in order to determine the areas of the communication program needing improvement.The evaluation of the program with regard to the role-playing with the SP and the feedback from them after it produced some interesting and significant results,with students feeling that the procedure for providing the feedback and teacher engagement in the small group discussion (SGD) required the most improvement (ratings of 10.22 and 5.10,respectively).These results indicate that our communication training program utilizing PBL and SP is a useful way for students to acquire communication skills and of increasing their motivation towards such training.
In April 2008,the Japanese government introduced a revised fee schedule for medical services.We report on pharmaceutical management for calculating administration fees under the revised schedule for the intensive care unit (ICU).We prepared a special form for standardizing pharmaceutical management for the ICU and its usefulness was evaluated through an interview survey of physicians.It was found that in the six-month period after the revised fee schedule was introduced,changes in prescriptions were necessary for 31 items in 94 cases (total interventions : 564 cases) for the ICU and 31 items in 38 cases (total interventions : 359 cases) for the coronary care unit (CCU).The physicians were also questioned on the benefits of pharmacist participation in intensive care management.Many physicians in the ICU said that it was useful to be able to inquire about a patient's history of adverse effects and their frequencies and many in the CCU said that it enabled them to check patients' drug histories as well as the drugs that they brought to hospital easily.In both units,physicians desired information on proper doses of anti-MRSA agents and other antibiotics. The ICU management form we made was considered useful in that it allowed physicians to know about time-lapse circulatory dynamics and laboratory test results.Such information is necessary for pharmacotherapy used in the management of cardiovascular diseases.The form also provided documentation for drugs frequently requested by physicians and those requiring particular caution.
To investigate the relationship between stationing pharmacists in a ward and the proper use of drugs,we conducted a survey of the number of corrections made to prescriptions.The survey focused on dose regimen,dosage,date of beginning to take drug,suspension,deletion,and result of correction.We also examined the possibility of discovering errors in prescriptions in the dispensing room.In addition,we investigated the difference between the number of corrections to prescriptions between interns and other doctors and sent out questionnaires on stationing pharmacists in wards to doctors and nurses with a view to making further improvements in the future. The number of corrections to prescriptions increased by 250% after a pharmacist was stationed in the digestive surgery ward with corrections in the“change to dose regimen or dosage”and“change in time of taking drugs”categories increasing about 3-and 8-fold,respectively.This increase in the number of corrections to prescriptions was due to the pharmacist in the ward gathering a large amount of information on patients and/or better communication between them and other medical staff. The need for the above corrections to prescriptions was difficult to discover in a normal inspection in the dispensing room.It was also considered difficult to swiftly address the issue of prescription errors through teaching other medical staff about medications once a week. The results of our questionnaire survey showed that stationing pharmacists in wards was very helpful in ensuring the proper use of drugs and enhancing the safety of drug therapy through the prevention of medical errors.This was largely due to an increase in the amount of available information on patients and/or better communication between the pharmacist and other medical staff.