Drug shortages have been a serious problem in Japan since February 2021, triggered by violation of the pharmaceutical manufacturing regulations by companies producing generic drugs. This study aimed to evaluate the usefulness of an institutional decision support protocol for the drug shortages; the protocol enables pharmacists in our hospital to change out-patient prescriptions when prescription queries are received from community pharmacies. We analyzed the records of prescription queries from community pharmacies regarding out-patient prescriptions in a five-month period before the beginning of the drug shortages and in a five-month period after the shortages began. We found that the ratio of the number of prescription queries due to unavailability of the medicine per out-patient prescription had significantly increased in the period after the onset of the drug shortages, from 0.06％ (38/66,792) to 0.57％ (398/70,104). The institutional protocol was applied to the majority (75.4％, 300/398) of the prescription queries due to unavailability of the medicine during the drug shortage. These results suggest that our institutional decision support protocol effectively reduced pharmacists’ workload by decreasing the time required to process prescription queries resulting from drug shortages.

The responsibilities of pharmacists working in hospitals have changed significantly over the past 30 years. This study aims to find stimulating factors during the development process of pharmacists in hospitals, and also clarify the development process. To ascertain the development factors, we conducted a 32-question questionnaire for 320 pharmacists who had been working in hospitals for more than 5 years and aged 30 years or older. Then we performed the factor analysis. Furthermore, to clarify the development process, semi-structured interviews were conducted with 9 pharmacists with similar backgrounds and analyzed using the Modified Grounded Theory Approach: M-GTA. Through the factor analysis, 4 development factors were extracted: “Self-reflection”, “Providing safe pharmacotherapy”, “Building trust in relationships with patients”, and “Practicing medical team”. Based on M-GTA, we showed the development process consisting of 4 core categories: “Responsibilities of pharmacists in hospitals”, “Improving patients’ quality of life”, “Contribution to society”, and “Self-reflection”. Quantitative and qualitative analysis revealed similar factors. “Responsibilities of pharmacists in hospitals” and “Improvement of patients’ quality of life” were considered to be the behaviors based on the concept of pharmaceutical care. “Contribution to society” was based on the public perspective of responding to the needs of Japanese society. The development process in which “Self-reflection” for pharmacists supports continuous maturation was revealed.

Risk factors leading to the development of tumor lysis syndrome (TLS) in multiple myeloma chemotherapy are itemized in the TLS guidance, but the specific conditions are not specified. While the introduction of one new drug after another improves the outcome of multiple myeloma treatment with chemotherapy, the risk of TLS is expected to increase, and further clarification of risk factors will be necessary in the future. Therefore, in this study, we retrospectively investigated the occurrence of TLS in the first course of chemotherapy for multiple myeloma in our hospital between January 1, 2020 and December 31, 2022, and examined the risk factors leading to TLS. Univariate analysis results suggest that ISS stage III is a TLS risk factor with a significant difference as indicated in the TLS Guidance. Elevated β2-microglobulin, also a tumor marker for multiple myeloma, is also suggested to be a TLS risk factor in multiple myeloma chemotherapy with significant differences, although this factor is not indicated in the TLS guidance. We report these results here because we believe that they can be used to assess the risk of TLS occurrence in future multiple myeloma chemotherapy and contribute to the development of supportive care used for TLS prevention.