The actions for taking medicines are restricted by the progress of joint destruction in patients with rheumatoid arthritis (RA). Therefore, medication support by pharmacists is necessary for these patients. However, no method has been developed to evaluate the degree of action disability for taking medicines. On the other hand, the degree of physical disability in patients with RA could be evaluated using the health assessment questionnaire (HAQ). In this study, we conducted a questionnaire survey that included 10 items related to the actions for taking medicines among 22 patients with RA. We analyzed the relationship between questionnaire survey and HAQ evaluation to determine the start timing of medication support in these patients. The result suggests that the ratio of patients who needed medication support increased steadily as the HAQ score increased. In addition, the questionnaire survey and HAQ evaluation showed a strong correlation (correlation coefficient, r = 0.75; P < 0.05). Therefore, this study clarified that the HAQ score could be a useful scale for identifying the degree of action disability for taking medicines in patients with RA. Furthermore, we could identify the start timing of pharmacist medication support by calculating the cut-off values on the basis of the HAQ score. In conclusion, we could contribute to the practice of medication support for patients with RA from a new viewpoint.

The most frequently reported medical incidents were drug-related and made by nurses.

Excessive dosing can cause adverse reactions and possibly lead to patient deaths. On the other hand, underdosing can delay treatment and prolong hospitalization. We investigated drugs associated with and factors leading to excessive dosing or underdosing incidents to clarify when pharmacists should intervene to reduce medication-related incidents. We analyzed incident reports collected by the Japan Council for Quality Health Care between January 2009 and June 2015. In total, we found 3,024 cases of excessive dosing and 2,119 cases of underdosing. In the excessive dosing group, dosing errors and the administration of an excessive dose without an order to do so comprised 785 cases and 482 cases, respectively. In the underdosing group, there were 902 cases of dosing errors and 366 cases where the dose was discontinued too early.

We used logistic-regression analysis to compare cases of causative drugs and incident factors with dosing errors and other medical incidents. Our analysis revealed that there was a significant association between steroids, narcotic analgesics, antibacterial drugs and both excessive dosing and underdosing incidents. Also, there was a significant association between nurses not confirming the correct dose and misdosing incidents.

It is easy for dosing errors to occur with the aforementioned drugs because the correct dosage varies with the patient's age, renal function, overall condition, and test results. These findings suggest that pharmacists in hospital wards need to check the correct dosage before administering the medication to prevent dosing errors.

A pharmacist outpatient service for patients receiving monotherapy with oral anticancer drugs aims to improve safety and medication continuation through pre-examination interviews. We assess medication adherence and monitor chemotherapy-induced adverse events by referring to patientsʼ complaints of symptoms and their medical diaries. In addition, “unused prescribed medicines” can also be a useful information resource. However, unused medicines are becoming a large-scale problem in Japan, thus leading to lower therapeutic effects and higher healthcare costs. In this study, we interviewed 270 patients (cumulative total: 1,385, monthly average: 153.9) from January 1 to October 31, 2017. Adjusted numbers of unused anticancer drugs were 96 and those of unused medicines for supportive care were 420, including moisturizing creams and steroidal ointments (23.1％), antidiarrheal drugs (18.1％), and antiemetic drugs (8.1％). We calculated the reduction in healthcare costs as JPY 5,045,585.5 (monthly average: JPY 560,621) for all unused medicines and as JPY 4,699,791.6 (monthly average: JPY 522,199) for only unused anticancer drugs. Anticancer drugs went unused because of chemotherapy-induced adverse events (grade 1: 37.3％, grade 2: 60.8％, grade 3: 2.0％) and failure to take them as prescribed. However, the chemotherapy discontinuation rate caused by adverse events was only 6.8％ through our continuous interventions. Chemotherapy with oral anticancer drugs needed to be discontinued appropriately in cases of developing grade≧2 adverse events; therefore, unused medicines exist. This pharmacist outpatient service can also lead to major reductions in healthcare costs through management of unused medicines.

A survey was conducted among patients that use health insurance pharmacies to determine the importance of drug consultation contents that are discussed during “holiday and night hours” and “regular open hours”. We investigated differences in the degree of importance in consultation topics for each drug between “holiday and night hours” and “regular open hours”. Also, for each time period, we also attempted to identify priority drug consultation topics for multiple medications. Three important consultation topics during “holiday and night hours” were found to be “drug interaction”, “actions to be taken in an emergency” and “whether or not to take a medication”. When drug consultation topics were compared between “holiday and night hours” and “regular open hours”, topics regarding “expiration date” and “indication” were found to be of higher importance during “regular open hours”. In regard to ideal patient consultations at pharmacies, based on the fact that i) the consultation contents differ depending on the patient's background and the time of day, and ii) the patient's needs differ from the topics of information covered when providing medication instructions and other information, the above results suggest that consultations need to be improved and aligned with the patient's needs.

In principle, valganciclovir (VGCV) should be used to treat patients who develop Cytomegalovirus (CMV) infections after lung transplants. The main adverse event of VGCV is leukopenia. However, the risk factors for VGCV-induced leukopenia have not been clarified. In this study, we examined the risk factors for VGCV-induced leukopenia. It is suggested that age, positivity for CMV antigenemia, interstitial pneumonia, and the patient's renal function before the administration of VGCV are strongly associated with VGCV-induced leukopenia. In addition, during examinations of the relationships between renal function or the VGCV dose and leukopenia it became clear that relatively high doses of VGCV were administered in the leukopenia group compared with the non-leukopenia group despite the fact that the former group exhibited low renal function. In conclusion, it is important to gradually adjust the dose of VGCV to 450 mg/day, 450 mg every other day, or 450 mg three times a week according to the patient's renal function in order to prevent leukopenia.

In order to promote Antimicrobial Stewardship (AS), prospective audit and feedback (PAF) is recommended. In our hospital, pharmacists have been conducting PAF for patients using notification antibiotics (eg, carbapenem, anti MRSA drug, and tazobactam/piperacillin). In this study, we investigated the intervention status of PAF by pharmacists for patients receiving intravenous antibiotics, and aimed to collect data that efficiently and effectively contribute to the spread of AS. Data were collected from February to April 2017. A total of 3,117 patients were monitored during this period, and it took an average of 7.2 hours per day to complete PAF. In a total of 203 prescription improvement proposals (acceptance rate: 88.7％), 152 (74.9％) were made for patients using non-notification antibiotics. The median number of proposals and the number of days since the start date (day 0) of each proposal were as follows: “usage and dose change” were 91 cases and 1 day (interquartile range: 1-3.5 days), “drug change” were 63 cases and 3 days (2-4 days), “drug end” were 37 cases and 7 days (5-10.25 days), and “culture request” were 12 cases and 3 days (1.5-4 days). The total number of proposals received until the third day was 117 (57.6％). This study will help pharmacists in selecting patients who should be monitored and setting surveillance timing in order to achieve an efficient and effective PAF.

In response to the “Pharmacy Vision for Patients in Japan,” the family pharmacist system began in 2016. Gifu Pharmaceutical University, in collaboration with the Gifu Prefectural Pharmaceutical Association, investigated the correspondence situation of pharmacies one year after the system commenced. Items surveyed in this study were dispensing fees, prescription checking fees, and so forth. We divided the pharmacies into family pharmacies (certified as a family pharmacist), and control (not certified as a family pharmacist) groups. The dispensing fees and prescription checking fees, such as preventing duplicate administration and drug interactions, were significantly higher in the family pharmacy group. We also investigated the awareness of the function and role of pharmacists. Most pharmacists in the family pharmacy group recognized the role of pharmacists as consultants for residents. Findings suggest that family pharmacies fulfill the function required by the pharmacy vision for patients, and have a high awareness of community health consultation.