Information is essential in the risk management of treatment after admission.With this in mind,we created a system allowing information regarding medicines brought to hospital by inpatients to be shared among hospital medical staff.It is based on electronic medical records and permits the administration of medicines patients have brought to hospital to be confirmed following their admission.In the present study,we gave a questionnaire to doctors and nurses so that they could evaluate the functionality of the system.The results were evaluated using customer satisfaction (CS) analysis.We also examined the amount of reduction in drug purchase costs through the use of medicines brought to hospital by inpatients.For doctors,CS analysis showed that the display of medicines brought to hospital by inpatients on an electronic medical record screen required improvement.For nurses,the results of CS analysis indicated that they were satisfied with the system's functionality.Use of medicines brought to hospital by inpatients after admission led to average monthly savings in hospital drug purchase costs of 1,345,473 yen.In conclusion,our risk management system has high utility in view of its functionality and contribution to improving hospital management.
It is not uncommon for tuberculosis patients taking 3 or 4 kinds of antituberculous agents long-term to develop adverse effects such as rash or hepatic dysfunction.However,the frequency of rash is unclear because many cases are based on patients' self-reports.The purpose of this study was to clarify the incidence of rash caused by antituberculous agent as well as the relationship between rash and other factors such as other adverse effects,clinical test values and period of taking antituberculous agents until appearance of rash. We conducted a retrospective search of medical records for inpatients with tuberculosis at Tokyo Hospital from October 1,2004 to September 30,2006.There were 266 subjects and rash developed in 100 of them (38%).In most cases,the rash was only mild and easily controlled with antiallergics.However,rash was severe in 26 patients requiring the reduction or discontinuation of antituberculous agents.We noted no difference in rash occurrence rate among prescriptions for antituberculous agents and no relationship between rash and other factors was observed.These results indicate that the frequency of rash caused by antituberculous agents is high and that it is important to judge the severity of each case in order to perform appropriate treatment.
Concern about rhabdomyolysis,an adverse effect of 3-hydroxy-3-methylglutaryl (HMG)-CoA reductase inhibitors (statins),is considered to be a cause of poor compliance among patients taking them.In this study,we investigated the effect on drug compliance of providing patients with information on rhabdomyolysis as well as problems in the methods by which pharmacists and physicians provide such information. We conducted a questionnaire survey of pharmacists working at pharmacy outlets between September and October 2006,in which they were asked about patients expressing concern with respect to rhabdomyolysis,reduced compliance in patients due to such concern and other factors that adversely affected patient compliance.We received responses from 187 pharmacists which showed that many pharmacists had been asked questions about rhabdomyolysis by patients who were extremely worried about it.They also indicated that 2 factors causing concern about rhabdomyolysis and reducing drug compliance were“Patient ignorance concerning adverse effects”and“Pharmacist failure to provide adequate information on adverse effects”.These results suggest that it is important for pharmacists to effectively address patient concerns about adverse effects and provide them with information in an appropriate manner in order to reduce patient anxiety concerning medication.
Identification of the gene encoding human vitamin K epoxide reductase complex subunit 1 (VKORC1 ),the main target molecule of coumarin derivatives,has contributed to clarifying racial differences in susceptibility to warfarin (Wf).However,although the discovery of genetic polymorphisms of the VKORC1 gene greatly aided understanding of the causes of great inter-individual variation in the response to Wf,a means of determining the optimal maintenance dose of the drug for each patient has not yet been established. From the viewpoint of application to both research and routine laboratory testing in the near future,we established a rapid and simple,simultaneous genotyping method for 2 known critical genetic factors,VKORC1 and CYP2C9 .The basic principle of this method is multi-primer PCR in which the genotypes of these genes are determined within 2 hr using a single thermal cycling condition.The intensity of the band amplified from the CYP2C9*3 allele is much greater than that obtained with the method currently used,indicating that the new method would be advantageous in visual diagnosis.Furthermore,since this method was applicable to non-blood derived samples,it would be suitable for a wide variety of patients whose blood is hard to collect,such as small children suffering from Kawasaki disease,or those with few leucocytes due to the adverse effects of chemotherapy with anti-cancer agents.
At Kyoto University Hospital,we introduced an electronic medical recording system in October 2005.We then investigated interventions in the dispensing room as well as the usage of electronic medical records in our satellite-like pharmacy from June through August 2007.The number of prescriptions in this period was 29,618,and we had questions concerning 840 of them,a quarter of which could be answered using electronic medical records.Of the 640 prescriptions that we contacted physicians about,either asking questions or making recommendations,82.5% were changed.On comparing the pharmaceutical interventions in the dispensing room made this time with those made in the course of conducting pharmaceutical care services in our previous report of 2003,when an electronic medical recording system had not be introduced,pharmacists mainly made recommendations to physicians based on standard pharmacotherapy,such as those concerning inappropriate dosages,indications and drug interactions (69%),and pointed out errors in prescriptions (15%).However,pharmaceutical care interventions had also been based on standard therapy in consideration of individual patient backgrounds,such as those concerning dosage adjustment in view of patient renal function,and adverse effects.For dispensing,our findings suggested that though the intervention rate was not very high,hospital pharmacists had been able to conduct interventions based on standard pharmacotherapy covering all types of patient.In addition,ward pharmacists had been able to conduct pharmaceutical care interventions for specific patients based on individual situations. In conclusion,the results of our investigation show that clinical pharmacists in the dispensing room and wards are able to work together in promoting optimal pharmacotherapy which prevents various risks.
For the objective structured clinical examination (OSCE) used in pharmaceutical education,it is necessary to assess students’skills and attitudes before their clinical practice.Five typical assignments that have been used to evaluate examinee’s performance in the OSCE are as follows : medical interviews,dispensing medicines,aseptic dispensing,dispensing audit and drug counseling.We added prescription audit as a new assignment,with an error included in it.The prescription audit materials consisted of prescriptions for 2 drugs and their package inserts. In this study,we evaluated the scores obtained in the 1st trial OSCE at Hoshi University,which had the following 3 assignments :“prescription audit”,“dispensing audit”and“aseptic dispensing”.We also examined the degree of difficulty and validity of evaluation questionnaires used in the two-stage item-based rating scale of the“prescription audit”.The results of the two-stage item-based rating evaluation suggested that the“prescription audit”was more difficult than“dispensing audit” and“aseptic dispensing”,and the evaluation questionnaires for“prescription audit”were mostly rated as valid,though the basis of evaluation for a questionnaire concerning“manner of writing of references”was ambiguous to persons doing the evaluation.On the other hand,overall evaluation scores for“prescription audit”were similar to those for“dispensing audit” and“aseptic dispensing”. We feel that the difficulty of the“prescription audit”would be manageable and based these results,conclude that it would be a good assignment for pharmaceutical OSCE.
Cilostazol is the first antiplatelet agent to have evidence of efficacy in the secondary prevention of lacunar infarcts.However,since some patients develop palpitation and tachycardia after having taken cilostazol,we decided to investigate the occurrence of these adverse effects.We found that cilostazol significantly increased pulse rate as compared with before administration in 65.3% of patients and the rate for palpitation was 12.2% and that for tachycardia 24.5%.The incidences of these adverse effects were greater than those reported in the clinical trial on cilostazol.Also,28.6% of patients had discontinued cilostazol due to adverse effects such as palpitation,tachycardia,headache,brain infarction relapse,and decreased blood pressure.As the rates for adverse effects of cilostazol were higher than those stated in past package inserts,it is necessary to monitor patients for their appearance.We must also provide them with up-to-date information on the adverse effects that could appear.
Hepatotoxicity associated with voriconazole (VRCZ) is a clinically significant adverse effect,and regular liver function tests are needed to detect it during the early stages.Although information regarding the clinical features,outcomes and risk factors of VRCZ hepatotoxicity is considered to be important in ensuring the proper management of antifungal therapy,such information has not been sufficiently reported. In this retrospective study,we evaluated VRCZ-related hepatotoxicity outcomes.Hepatotoxicity due to VRCZ occurred in 24 of 59 patients (40.7%),and was frequently observed within 3 weeks after the initiation of its administration (16 of 24 patients ; 66.7%).In 10 of the 59 patients (16.9%),the drug had to be discontinued due to abnormal liver function.On performing multivariate analysis using logistic regression to identify risk factors influencing hepatotoxicity due to VRCZ,we found that overdosing,i.e.administering doses exceeding recommended weight-based doses,tended to increase the occurrence of hepatotoxicity (Odds ratio=5.271,95% confidence intervals 0.925-30.045,P=0.061). In conclusion,our findings suggest that there is a need for weight-based standard dosage adjustment of VRCZ to avoid the risk of hepatotoxicity.In addition,we recommend frequent monitoring of liver enzymes to prevent serious hepatotoxicity within 3 weeks of initiating administration of VRCZ.
At the time of introduction of the electronic medical records system,we introduced additional systems such as those for chemotherapy regimen registration and prescription inspection in order to carry out cancer chemotherapy treatments safely. Later,on conducting an investigation of 139,615 prescriptions for injectable agents from September 2006 to August 2007,we found that our systems had reduced the numbers of inquiries such as those concerning omissions and overdosage.There were 407 inquiries concerning the 16,287 anticancer agent prescriptions among them and they uncovered prescribing errors such as selection of wrong regimens and making mistakes in cycle counts,that could have led to medical malpractice.We also found that inquiry rates were higher for breast cancer and colorectal cancer regimens. Our findings indicated that mechanical prescription checking systems alone are not sufficient for ensuring safe treatment with anticancer agents and therefore the checking of prescriptions by pharmacists is considered to be very important.
As little information on the efficacy and safety of generic drugs has been produced,accessing such information can be difficult,often requiring independent searches.In Japan,there are currently 2 types of literature databases,those that are free (Free DBs) and those for which a charge is made for usage (Charged DBs).The aim of this study was to evaluate the utility of Free DBs in obtaining information on generic drugs. The following DBs were accessed : Free DBs : iyakuSearch (Japan Pharmaceutical Information Center),CiNii (National Institute of Informatics),and Medical*Online (Meteo Inc.) ; Charged DBs : JMEDPlus (Japan Science and Technology Agency) and ICHUSHI Web (Japan Centra Revuo Medicina).Articles published between 2003 and May 15 th 2008 were searched,using“Generic drugs”as a keyword,and the number of overlapping results between Free and Charged DBs was examined.The overall rate of overlapping articles between Free and Charged DBs was 70%,with a rate for review articles of 30% and a rate for conference abstracts of 50%. Our results suggested that Free DBs were useful but we consider that they are not effective for searching review articles.A meta-search engine that can search among both Free and Charged DBs is thus required.