Kobe University Hospital created a simplified 14-item protocol for resolving out-of-hospital prescription queries. The protocol was implemented in September 2016 in nine community pharmacies. If prescriptions were changed as per the new protocol or via typical query procedures, we asked community pharmacies to fax the changed prescriptions, and the hospital pharmacists, rather than medical doctors, modified the prescription history. To evaluate the effects of this simplified protocol, we examined the number of changed outpatient prescriptions and administered questionnaire surveys to community pharmacists and hospital-based medical doctors. The ratio of changed to total outpatient prescriptions decreased in January 2017 (4.1％) compared with those in September 2016 (6.4％). Ultimately, more than half of all outpatient prescriptions were changed by the protocol. Drug brand name changes accounted for 52％ of the total changes during both September 2016 and January 2017, but the proportion of residual medicine adjustment increased from 12％ in September 2016 to 26％ in January 2017. Due to the questionnaire survey, 33％ of surveyed medical doctors indicated that they knew or had heard of the protocol, and 54％ responded that the protocol decreased the burden of addressing outpatient prescription queries. The community pharmacies reported that the burden of clarifying outpatient prescription queries decreased. In conclusion, implementation of the simplified protocol for outpatient prescription queries improved medical efficiency and may help promote cooperative streamlining of community patient pharmaceutical care services.
Although naloxone is used as an opioid antagonist, naloxone has a short half-life compared with opioids such as morphine and fentanyl. Therefore, there is a risk of developing a re-respiratory depression after administering an initial dose of naloxone. In our hospital operating room, after the first administration of naloxone, incident cases that resulted in the re-respiratory depression were reported. In order to standardize and minimize the use of naloxone during the perioperative period, our hospital developed a new protocol for the use of opioids and naloxone in the post-anesthesia care unit. With the new protocol, naloxone administration was strictly managed by a clinical pharmacist to avoid arbitrary usage and to better monitor the incidence of adverse events. To minimize the need for opioid antagonists during the perioperative period, we also re-educated all anesthesiologists at our hospital on the proper use of opioids. We then retrospectively examined opioid usage, naloxone usage, the incidence of respiratory depression, and the incidence of adverse events before and after implementing the new protocol. The results indicate a significant reduction in the percentage of cases in which naloxone was used after the new protocol was implemented (P = 0.002). Naloxone was only used in one case, after the new protocol was implemented. Compared with the previous management method, there was a reduction in the usage of morphine after the new protocol was implemented. Based on the results of this study, the new protocol appears to effectively minimize the usage of naloxone during the perioperative period.
Magnesium oxide tablets are commonly used as antacids or laxatives. They are mainly formulated for the elderly to relieve constipation. Although these tablets normally undergo rapid disintegration, moisture absorption causes an increase of the disintegration time. However, magnesium oxide tablets are sometimes dispensed in a one-dose package. In this study, we examined the effects of moisture absorption of a magnesium oxide tablet stored in rotor cassettes on formulation stability. The tablets were stored in rotor cassettes under 55％RH or 75％RH conditions for 7 days. These tablets were analyzed for weight, hardness, disintegration time, dissolution test, friability, and breakage after storage in rotor cassettes. Although the weight increased in a humidity-dependent manner, moisture absorption of the tablets significantly decreased when a desiccating agent was used. In contrast, the other tablet properties showed little difference. We further examined whether moisture absorption of the tablets stored in rotor cassettes caused deterioration in quality when stored in a one-dose package under the condition of 75％RH. Our results show that moisture absorption of the tablets enhanced hardness and delayed disintegration time. This delay in disintegration time of magnesium oxide tablets increases the risk of choking on a tablet and reduces the compliance of patients who have difficulty swallowing tablets. In conclusion, we demonstrated that moisture absorption affects the quality of magnesium oxide tablets while the preservation after one-dose packaging. It is important for pharmacists to carefully consider the effects of moisture absorption of hygroscopic tablets stored in rotor cassettes, when tablet packaging machines are used.
Pharmacists working in the community must be able to accurately triage customers who present with a medical complaint or request advice. In Japan, one of the problems in pediatric emergency medical care is that parents expect an immediate consultation regardless of time or place. Accurate pharmacist triage is expected to help meet the need for these consultations. The aim of this study was to assess pharmacists’ triage of pediatric emergency patients and the educational needs among community pharmacists working in pharmacies and drugstores. An anonymous questionnaire survey was conducted with 1273 pharmacists employed by Cocokara fine Inc., and 238 responses were received. Only 33.2％ of the respondents had heard of pharmacist triage and only 43.7％ reported triage experience with pediatric emergency patients. When asked about their anxiety levels at the time of pediatric triage, 74.0％ of pharmacists responded “I was sometimes anxious” and 10.6％ responded “I was always worried”. When pharmacists who had no triage experience in pediatric emergency cases were asked how they would feel if they encountered such a case, 93.3％ responded “I think I would be anxious”. A large number of respondents (89.5％) indicated a willingness to attend triage training sessions or workshops. The survey results indicate that almost all community pharmacists working for pharmacies and drugstores lack both awareness and experience of triage for pediatric emergency patients. Appropriate education is required for them to develop the necessary skills for pharmacist triage in pediatric emergency cases.
In recent years, transdermal therapeutic systems have been widely used, while information regarding the release of drugs from such preparations and their pharmacokinetics remains insufficient. A “release test for preparations for cutaneous application” was recently published in the 17th edition of The Japanese Pharmacopoeia (JP17). In an effort to evaluate the release test method described in JP17 and its usefulness, we compared the release behavior of a bisoprolol patch preparation determined using the paddle-over-disk method described in JP17 with the results obtained in our reported clinical study. Several types of release fluids with pH values from 4.5 to 8 and salt concentrations from 10 to 100 mM were used in the release test. No influence of either the pH or the salt concentration of the release fluid on the release behavior was observed. The time required for 100％ release was approximately 6 hours, which was consistent with the results obtained in the clinical study. The results suggest that the patch preparation exhibited a consistent release behavior that can be used to evaluate pharmacokinetic profiles in clinical studies. Consequently, the release test method described in JP17 represents a useful method for determining drug release from patch preparations.
We conducted multidisciplinary medical care team education as a joint class by Gifu Pharmaceutical University, Gifu University and Heisei College of Health Sciences. We conducted a questionnaire survey on 84 pharmacy students before and after training in order to assess the effect of interprofessional education. Questionnaire items are the importance of each item related to interprofessional collaboration, self-assessment of SBOs (specific behavioral objectives) on the medical care team, KiSS-18 (Kikuchi's scale of social skills: 18 items), RIPLS (readiness for interprofessional learning scale) and IEPS (interdisciplinary education perception scale). The score before and after training was compared using a Wilcoxon signed-rank test. The importance of items related to interprofessional collaboration was reduced in “Patients-/Client-/Family-/Community- Centered” and “Role Contribution”. In medical care team SBOs, the scores increased in all four items. In KiSS-18, the scores increased in several items among the 18 items. In RIPLS, the scores increased in many items among the 19 items, which included “Learning between health and social care students before qualification and for professionals after qualification would improve working relationships after qualification/collaborative practice” and “I would welcome the opportunity to share some generic lectures, tutorials or workshops with other health and social care students/professionals.” In IEPS, the scores increased in many items among the 18 items, which included "Individuals in other professions think highly of my profession.” We found that interprofessional education improved the self-assessment of medical care team SBOs, social skills, learning preparation/orientation, and recognition of multidisciplinary medical care team education in pharmacy students.