In the 2012 revision of the Japanese medical payment system, a new payment fee was established for inpatient pharmaceutical services. These services are expected to reduce the burden of medical doctors and other staff and improve medical safety and the quality of pharmaceutical therapy. To charge the new fee, pharmacists should be assigned to all wards. Many hospitals aim to achieve this. To our knowledge, however, there are no reports on the effects of full-time allocation of pharmacists in every ward on medical safety. Nagoya University Hospital has allocated full-time pharmacists to every ward since April 2011. In the present study, to evaluate its effect on medical safety, we analyzed incident reports related to medicine from April 2010 to March 2013. As to the number of incident reports, there was little difference among the 3 years, but a significant increase was observed in the percentage of incident reports that contained the word ‘pharmacists’ in 2011 and 2012. Detailed analysis revealed that the percentage of incident reports indicating that other staff consulted with a ‘pharmacist’ in 2011 and the percentage of incident reports indicating incidents found by ‘pharmacists’ in 2012 were both significantly higher than those in 2010. These findings suggest that the full-time allocation of pharmacists in every hospital ward results in promotion of team-based healthcare services and medical safety.
We studied the risk avoidance effect on prescriptions by clinical pharmacists and the awareness among physicians and nurses about the risk control conducted by pharmacists. The design is a prospective observation study in a single community hospital over a 10-month period. Main outcome measures were the risk avoidance ratio among total cases in which pharmacists determined whether the inquiries on prescriptions were related to effective risk avoidance on a real-time basis. During the study period, there were 397 inquiries. The ratio in which the physicians accepted the recommendation through the inquiries was 80.5%. And 58.9% of the total inquiries were evaluated as effective for the risk avoidance of adverse drug effects and events. As far as medication counseling is concerned, the rate of acceptance was 81.2%, and the rate of risk avoidance was 72.7%. The occurrence of medication changes followed by the inquiries was 17 cases a month on average, which was well above that of a nationwide survey conducted in 2010. Following the questionnaire about the ward pharmacist system, all the physicians and nurses have had experience in consulting with pharmacists and were familiar with the system. Through the consultations, 80% of physicians and 90% of nurses responded that they were able to avoid the risk. As compared with another survey, the risk reduction and avoidance based on pharmacological management were highly evaluated as an advantage of the ward pharmacist system similarly. We conclude that the risk avoidance effect by ward pharmacists was explicit and evaluated highly by physicians and nurses.
Chemotherapy regimens using cisplatin (CDDP) have rarely been applied to outpatients because they require vigorous hydration to reduce CDDP-induced nephrotoxicity. In this study, we investigated the protective effect of oral rehydration solution (ORS) on CDDP-induced nephrotoxicity in rats, which could be applicable to outpatients for oral hydration. Two mg/kg CDDP was intraperitoneally injected into male F344 rats (n = 8) once a week for 7 weeks. A total of 60 mL/kg/day water, ORS, or modified ORS (MOS: chloride-free ORS) was orally administered for hydration. Changes in renal functions were evaluated by plasma creatinine, creatinine clearance, and histopathological evaluation of the kidney. Urinary excretion of platinum and chloride was also measured. Evaluations of body weight (205 ± 13 vs 238 ± 7 g, P = 0.002) (Mean ± SD, water vs ORS), serum creatinine (0.69 ± 0.19 vs 0.41 ± 0.05 mg/dL, P = 0.023), creatinine clearance (0.48 ± 0.22 vs 0.74 ± 0.23 mL/min, P = 0.044), and histopathological evaluation at the 7th week revealed that nephrotoxicity was prevented more effectively by oral hydration using ORS than using water. MOS did not show any protective effects. Urinary platinum excretion after CDDP administration was similar between water and ORS. Urinary chloride concentration was higher after ORS administration. ORS reduced CDDP-induced nephrotoxicity in rats, probably through providing chloride ions to prevent CDDP activation in renal tubules and to promote CDDP excretion. As the clinical application of ORS in cisplatin regimens may contribute to release from infusion, the shortening of the bed residence time and patient's quality of life improvement, safety and usefulness of ORS during cisplatin chemotherapy need to be evaluated.
Since drug-induced hearing loss markedly diminishes the quality of life, the early detection of such hearing impairment is recommended. We evaluated the utility of tablet device applications for the early screening of hearing loss preliminarily. The subjects were 14 healthy young adults (in their 20's) and 6 middle-aged and elderly adults (30's or older). As the standard device, we employed a pure-tone audiometry device used in the clinic. In the pure-tone hearing test (125 - 8,000 Hz) using the standard device, there was no significant difference between young and middle-aged/elderly subjects. However, the middle-aged/elderly subjects revealed a significant difference in the higher frequency range (12,000 Hz or more) compared to the young subjects in the hearing test using two different applications, “Senses” and “Audiometry”. The results indicated the different characteristics of the standard pure-tone audiometry device and tablet device applications. Although we should clinically confirm hearing loss using the standard pure-tone audiometry device, the tablet device application “Senses” may be useful for the early and simple screening of high-frequency hearing loss such as drug-induced hearing loss.
The continual development of mobile technology and spread of mobile devices have led to the use of personal digital assistants (PDAs) in medical fields. In this report, we describe the applications of PDAs, such as smartphones, in pharmaceutical practice. Participants included pharmacists in university hospitals (n = 121), community pharmacies (n = 100), and 6th-year pharmacy students (n = 166) who had already successfully completed their clinical rotations. We conducted questionnaires regarding PDA use frequency and interest in future PDA use, which were evaluated using 4-point scales. These two variables were compared statistically between the university hospital pharmacists and community pharmacists. The data from the pharmacy students were analyzed separately using descriptive statistics. For university hospital pharmacists, the top use for PDAs was as a personal scheduler; for community pharmacists, it was as a dispensing error prevention system. Most university hospital pharmacists reported high interest in future PDA use, mainly for obtaining practice guidelines and obtaining package insert information, while community pharmacists would use PDAs to obtain package insert information. For pharmacy students, PDAs were most often used to obtain package insert information; furthermore, pharmacy students showed high interest in future PDA use during hospital and pharmacy clinical rotations. As six interests regarding the use of PDAs in future pharmaceutical practice differed between the university hospital and community pharmacists (P < 0.05), PDA software applications should be tailored for each medical setting.
Polystyrene sulfonate drugs (PSS) are likely to adsorb coadministered drugs through ionic and hydrophobic interactions because of their chemical structures. Nine drugs frequently dispensed at our 3 pharmacies to administer with PSS concurrently were selected and examined for their adsorption in vitro to Kalimate® powder in pH 6.8. Cationic drugs in the solution, amlodipine besylate and dilazep hydrochloride hydrate were adsorbed almost totally, while anionic drugs, aspirin, furosemide and losartan potassium were only adsorbed in 0-15%. Non-ionic drugs, allopurinol, nifedipine and prednisolone were adsorbed to different extents, 9, 59 and 84%, respectively in proportion to their hydrophobicity (XLogP3). These data clearly indicate that cationic drugs and highly hydrophobic non-ionic drugs are susceptible to be adsorbed by PSS. The dissolution test of Adalat® L at pH 6.8, pH 4.5 and pH 1.2 in the presence of Argamate® Jelly showed that release of nifedipine was apparently depressed markedly at any pH. We propose that a description directing attention to the interaction with a wide range of drugs is added in the package inserts of PSS to avoid the occurrence of drug interactions.
Octreotide is often administered to patients by addition to total parenteral nutrition (TPN) as well as by subcutaneous injection. However, the concentration has not been determined to remain greater than 90% through the completion of its administration. This study investigated the stability of octreotide during administration in ELNEOPA No 1 TPN solution, a four-chambered duplex delivery system. The level of octreotide in the upper-chamber of the ELNEOPA No 1 duplex delivery system, pH 4.0, remained stable, whereas that in the lower chamber, pH 7.0, decreased to less than 90% of the initial concentration immediately after mixing. The final concentration of octreotide in pH 7.5 buffer solution was significantly lower than that in pH 5.1 buffer solution. The influence of pH was reversible. However, a fraction of octreotide suffered decomposition in pH 7.5 buffer solution. Hence, it might be suitable to inject octreotide into the upper chamber that has the lowest pH among the 4 chambers of the duplex drug delivery system used by ELNEOPA No 1. Reducing agents such as sodium hydrogen sulfite caused the concentration of octreotide to decrease. Although the mixed solution of the 4 chambers contains sodium hydrogen sulfite, the concentration of octreotide remained greater than 90% for about 3 days. The decrease in concentration caused by sodium hydrogen sulfite seemed to be protected by the co-presence of glucose or cysteine. The results of our octreotide concentration studies suggest the possibility that the therapeutic effects of octreotide administered via TPN would be equivalent to the effects following subcutaneous administration.
A 22-year-old man was admitted to the National Hospital Organization Osaka National Hospital for skin ulcers and chronic osteomyelitis. He did not have any renal dysfunction, and the wound culture on the fourth hospital day revealed the presence of methicillin-resistant Staphylococcus aureus. Therefore, he was treated with teicoplanin and vancomycin. However, a rash and pruritus appeared, following which these drugs were discontinued. On the 25th hospital day, his creatine phosphokinase (CPK) level was 104 IU/L, and on the 28th hospital day, he was started on daptomycin therapy (4 mg/kg/day). However, on the fourth day of daptomycin therapy, his CPK level rapidly increased to 2648 IU/L, and daptomycin was immediately discontinued. To our knowledge, thus far, there have been no reports worldwide of a patient with normal renal function who showed an increase in the CPK levels in early stage disease, due to daptomycin administration. Therefore, we believe that monitoring of CPK levels at the early stage of disease is important even in patients with normal kidney function.