To deal with drug shortages at the time of dispensing at pharmacies, home delivery services are sometimes employed. However, the impact of drug shortages that occur during the dispensing and delivering of drugs remains uninvestigated. Therefore, this study surveyed 41 pharmacies to improve safety in delivery after online medication instruction, and examine the countermeasures against drug shortages in pharmacies.

Analysis of the 27 valid responses showed that drug shortages during dispensing affected 1.48 per 100 prescriptions. Direct delivery by pharmacists or delivery services accounted for 71.1％ of the drug shortage responses. There were no patient-related health hazards because of delivery, but some pharmacies had delivery problems: returned (7.4％), delayed (3.7％), and mis-delivery (3.7％). Additionally, 14 pharmacies (51.3％) responded that drug treatment was improved by “checking medication status, leftover medication, and providing medication guidance” through direct delivery by pharmacists. The delivery-related concerns of dispensed medicines included the quality of dispensed medicines (25.9％); misdelivered/undelivered medicines (14.8％); and the handling of narcotics, psychotropic substances, and deleterious drugs (11.1％).

This study shows that, to provide drug treatment to patients without delays, strengthening the pharmacy’s function in the supply chain of pharmaceuticals (including inventory management and dispatch) is essential. Moreover, while cooperation with the delivery company is important to ensure safe and smooth delivery of dispensed medicines, regular visits by pharmacists to patients’ homes to check their medication status and physical condition are likely to further improve drug therapy.

Aspiration pneumonia (AP) accounts for approximately 80％ of pneumonia cases among the elderly, and its treatment can involve long-term administration of antibiotics and prolonged hospitalization. To optimize the treatment of AP, the antimicrobial stewardship team (AST) created and induced a clinical pathway (CP) for AP and evaluated its activities. First, we investigated the progress of patients treated for AP from January to September 2020. To address AP treatment issues, we identified three tasks: “antibiotics treatment,” “swallowing assessment,” and “early discharge support.” The AST developed and implemented the CP in November 2020. After the induction of the CP, the AST monitored the CP usage rate and appropriate use of antibiotics. Subsequently, clinical outcomes were compared in 142 patients before its induction from January to October 2020 and 115 patients afterwards from January to October 2021. After the induction of the CP, the median daily dose of sulbactam/ampicillin significantly increased from 6 to 9 g (P < 0.001). The water swallowing test evaluation significantly increased from 3.5％ to 38.3％ induction (P < 0.001). The median time to intervention for swallowing therapy was significantly shortened from 6 to 5 days (P = 0.023). The median administration duration of antibiotics was 8 days but significantly reduced to 7 days afterwards (P < 0.001). The median length of hospital stay significantly reduced from 20 to 19 days (P = 0.040). With the creation and induction of the CP for AP and post-induction monitoring, the periods of antibiotic treatment and hospitalization may be shortened.

The efficacy index of vancomycin (VCM), an antibiotic widely used in the critical care setting, is defined as an area under the time-concentration curve (AUC) ≥ 400, and an early loading dose is recommended to increase blood concentrations at an early stage. A correlation between the AUC up to 24 hours after the start of administration (AUC_0-24hr) and therapeutic effect has also been reported. However, there are few reports on the effect of the initial loading dose on AUC_0-24hr in the critical care setting. In the present study, we compared the rate of achieving an AUC_0-24hr ≥ 400 between the loading dose (LD) group and the no loading dose (ND) group in critically ill patients with impaired renal function or patients undergoing continuous renal replacement therapy. The rate of achieving an AUC_0-24hr ≥ 400 was significantly increased to 81.4％ in the LD group compared to 45.2％ in the ND group (P < 0.005), and the presence of a loading dose was extracted as a factor affecting the rate at which an AUC_0-24hr ≥ 400 was achieved with an odds ratio of 9.1. Administration of a loading dose of vancomycin in critically ill patients with impaired renal function or patients undergoing continuous renal replacement therapy may help achieve the target AUC earlier.