In April 2014, when the medical insurance system for medical service fees was revised, the required assessment of inpatients’ conditions for the addition of inpatient pharmaceutical service fees in long-term care beds was changed from being conducted at 4 weeks after hospitalization to being conducted 8 weeks after hospitalization. However, there have been no reports on the changes this has brought to inpatient pharmaceutical services in long-term care beds. Additionally, there have been no reports comparing the content of inpatient pharmaceutical services during the first 8 weeks with that after 9 weeks. Therefore, we investigated inpatient pharmaceutical services for 58 long-term care beds in Kibikougen Lumiere Hospital over 1 year.
The rate of pharmacist interventions for prescription optimization was eventually 60.9％ and the number of pharmacist intervention categorized according to subject was a total of 465. In addition, there were no significant differences between the first 8 weeks of hospitalization and after 9 weeks in the content of inpatient pharmaceutical services and in the rates of doctor acceptance of pharmacist interventions.
Notably, we estimated that there would be a reduction in the cost of medication of around 515,633 yen per year (8,890 yen per bed) as a result of withdrawal of medication through pharmacist intervention. Therefore, inpatient pharmaceutical services in long-term care beds should be continuously offered for patients staying at the hospital for more than 9 weeks.
The role of pharmacists in the palliative care team has been well researched. However, no studies have explored the pharmacist's role in outpatient pain clinics in Japan. A pharmacist's consultation service was begun at an outpatient pain clinic at Ashiya Municipal Hospital, for 2 hours, once a week. Our objective was to describe the pharmacist's interventions in the ambulatory pain care practice. This was a retrospective data analysis conducted at Ashiya Municipal Hospital. The pharmacist consulted 92 new patients from April 2014 through March 2015; 32 were male and 60 were female. The median age of the patients was 72.0 years (range: 18-94 years). The number of patients increased gradually by 8-10. The pharmacist provided all the medication after review at the first consultation. The average number of different kinds of medications that patients took was 7.3 ± 4.4. The pharmacist identified medication problems for the management of pain and advised the physician about the patients' pharmacotherapy. This is the first report of a pharmacist's role in an outpatient pain care setting. Pharmacists who are engaged in an outpatient pain clinic can play a pivotal role in the pharmacotherapy of pain by optimizing medication therapy, monitoring outcomes, and enhancing adherence through patient consultation.
Insulin degludec shows longer lasting and more stable anti-hyperglycemic effects than the conventional long-acting insulin analogs, glargine and detemir. An injection of degludec once a day may stabilize blood glucose levels in patients who have not responded to injections of glargine or detemir twice a day. In the present study, we retrospectively investigated the impact of switching basal insulin from glargine or detemir twice a day to degludec once a day in the morning on glucose levels in type 1 diabetic patients. In 11 study patients, HbA1c and glucose levels before breakfast were similar during a 6-month follow-up. The standard deviation of glucose levels was significantly lower 3 months after than before switching to degludec. No significant differences were observed in the frequency of hyperglycemia or hypoglycemia between before and after switching. While the dose of bolus insulin was similar, that of basal insulin was gradually decreased after switching. These results suggest that switching basal insulin from glargine or detemir twice a day to degludec once a day in the morning decreases the day-to-day variability before breakfast in glucose levels in type 1 diabetic patients and also reduces the frequency of injections.
The influence of the opioid oral rescue dose (RD) management method on opioids usage was investigated using electronic medical records in patients receiving opioid treatment from December 2014 to May 2015.
Thirty-one inpatients who received a continual opioid basal dose and RD were divided into two groups based on differences in the management methods of RD, self-management patients (SMPs) and nurse-management patients (NMPs). There was no significant difference regarding the rate of RD users, total use counts, or titration of the opioid dose between the groups of 15 SMPs and 16 NMPs. Moreover, there was no significant difference in these categories between the groups of 12 SMPs and nine NMPs in 21 patients who had received RD after hospitalization. NMPs showed a significant difference in the total use counts of RD between day time (9:00 am-9:00 pm) and night time (9:00 pm-9:00 am), whereas SMPs showed no significant difference. Furthermore, there was no significant difference in the rate of RD users between day time and night time B (1:00 am-5:00 am) in SMPs. However, the user rate in the day time was lower than that in the night time B in NMPs. NMPs might have to hesitate before pushing the nurse-call button for RD during the night time B.
In delivering modified FOLFOX or FOLFIRI treatment, Huber-pointed safety needles are commonly used to protect the patients from needle stick injury during withdrawal. But we noticed longer durations of levofolinate with oxaliplatin or irinotecan delivery when Huber-pointed safety needles were used in our hospital. Thus, we evaluated the differences in flow rate with respect to three variables: use of safety needles versus ordinary needles, the length of additional tube used and the gauge of needle. We found that the length of additional tube and gauge of needle affected the flow rate while the use of safety needles did not. Flow rates of 8.33 ± 0.12 mL/min and 11.90 ± 0.16 mL/min were obtained with the use of additional tubes of 450 mm and 100 mm respectively. The duration of chemotherapy was significantly shortened when the length of additional tube was changed from 450 mm to 100 mm in 9 patients with long chemotherapy duration (before 134.5 ± 13.8 min, after 123.33 ± 11.2 min, P = 0.03). The choices of chemotherapy delivery materials also seem to play an important role in safe and effective chemotherapy.
We examined factors that increase requests from family caregivers for the involvement of pharmacists in home healthcare. We recruited community pharmacies at a Kanagawa Pharmaceutical Association-sponsored workshop in which 48 pharmacies participated. Respondents completed a questionnaire survey between July and August 2015 regarding 5 to 10 clients aged 50 and older; 201 questionnaires were analyzed. The median number who recognized pharmacists' work in home healthcare (16 items) was 10 (interquartile range: 4-12). Meanwhile, 8 items had a recognition rate of under 50％. More than 70％ of all respondents answered in all items that pharmacists' work in home healthcare was important. The percentage of people who answered “always request pharmacist home visits even for a fee” was 19.9％ when multiple medicines were used (Case 1), 20.4％ when there were unused medicines (Case 2), and 39.3％ when narcotic analgesics were used (Case 3). The factors related to requests for pharmacist visits for home-care-patient with a problem related to polypharmacy or leftover prescription drugs were analyzed using association analysis; maintaining drug, checking for side effects, checking for drug interactions, advice for drugs, advice for hygiene control, supply of home medical equipment and hygiene products and supply of nursing care products. Thus, understanding of these seven factors may increase requests for the involvement of pharmacists in home healthcare. Therefore, pharmacists should instruct the public on not only drug treatment but also their role in home healthcare.
Reactivation of hepatitis B virus (HBV) has been reported in patients undergoing systemic chemotherapy or other immunosuppressive therapy, and prophylaxis of HBV reactivation is essential. The Japanese guidelines for HBV reactivation were published in 2009, but there have been some reports that the HBV screening prevalence was low. Therefore, we investigated the preventive measure of HBV reactivation in chemotherapy patients using the Plan-Do-Check-Act (PDCA) cycle and conducted a retrospective survey to clarify the efficacy of this measure. During the period from January 2015 to January 2016, HBV screening was defined as hepatitis B surface antigen, hepatitis B surface antibody, and hepatitis B core antibody. We compared screening rates before and after starting this measure (January 4, 2015 to July 12, 2015 and July 13, 2015 to January 22, 2016, respectively). Of 440 new patients who received chemotherapy, HBV screening rates before and after starting this measure significantly increased from 24.9％ to 79.2％. After starting this measure, we have carried out 6 cycles of the PDCA cycle. The HBV screening rates of each cycle were 63.3％, 65.7％, 82.1％, 86.7％, 87.9％, and 92.6％, respectively. Since the third cycle, ward-pharmacists have checked HBV screening, and the HBV screening rate has been maintained at 80％ or more. Despite the HBV screening rate not reaching 100％, these results suggest that the preventive measures of HBV reactivation using the PDCA cycle are highly effective for increasing the HBV screening rate.