Efficacy of the Checksheet for Appropriate Prescription of DOAC / 医薬品情報学

Objective: The use of direct oral anticoagulants (DOACs) has increased because they have some advantages over warfarin, such as fewer interactions and no requirement for coagulation monitoring in principle. DOACs have dose adjustment requirement based on renal function and other complex criteria that differ depending on specific DOAC preparations and indications. At the Nagoya City East Medical Center, DOAC dose‒related decisions previously depended on the knowledge and discretion of individual pharmacists. However, a dose checking sheet for DOACs (the Checking Sheet) was prepared and used on our electronic medical record system since September 2016 to increase the reliability of prescription checking, eliminate improper prescriptions, and ensure electronic documentation of pharmaceutical inquiries. In this study, we compared percentages of proper prescriptions before and after the introduction of the Checking Sheet to assess the effectiveness of its use, which has not been reported previously.Method: The percentage of proper DOAC prescriptions was used as a measure to assess the effectiveness of the Checking Sheet. We investigated DOAC prescriptions from March 2017, when the Checking Sheet system had been established, and compared those with prescriptions from March 2016 (before the Checking Sheet was introduced). Prescriptions of rivaroxaban, apixaban, edoxaban, and dabigatran for nonvalvular atrial fibrillation or venous thromboembolism were included; prescriptions dispensed outside the hospital were excluded.Result: DOAC prescriptions before and after the Checking Sheet introduction were similar in number. The percentage of proper prescriptions increased significantly from 82.4 to 94.3%. Among specific DOAC preparations, the number of improper prescriptions decreased significantly for apixaban and showed a tendency to decrease for rivaroxaban.Conclusion: The increases in the number of proper DOAC prescriptions observed after introducing the Checking Sheet showed that the Checking Sheet helped ensure a certain level of prescription checking, suggesting its usefulness for promoting proper DOAC use.

Establishment of Checking TPN Prescription Algorithm Based on Excel vba Technology / 中国药房

OBJECTIVE： To improve the efficiency and accuracy of checking total parenteral mutrition （TPN） prescription. METHODS： Excel vba technology was used to edit vba code and construct TPN prescription algorithm. The key indicators and standard of TPN prescription checking were determined. Established algorithm was used to check the prescriptions from PIVAS of our hospital in May 2018， results of which was compared with the results of manual checking （using potassium concentration， monovalent cation concentration and alanyl-glutamine combined with amino acid as indexes）. RESULTS： TPN prescription algorithm was established through confirming 17 key indicators as glycolipid ratio， heat-nitrogen ratio， monovalent cation concentration， the checking standard was set as. It took 15 seconds to check 2 638 TPN prescriptions received within one month in PIVAS of our hospital； 449 irrational prescriptions （excessive dose， incompatibility， inappropriate proportion and volume of nutrition） of them and reasons had been marked out. By comparing 3 evaluation indexes， 1， 1， 0 irrational prescriptions were checked by manually and 4， 12， 4 checked by established algorithm， respectively. CONCLUSIONS： TPN prescription algorithm can check prescription in batches based on Excel vba technology， and mark out the substandard prescription automatically. Hereby， it improves the efficiency and accuracy of TPN prescriptions by PIVAS.

Evaluation of Improvement Effects about Prescription Checking and Intervention Skills of Pharmacists in a Hospital / 中国药房

OBJECTIVE:To evaluate the improvement and rectification effects about prescription checking and intervention skills of pharmacists. METHODS:By retrospective investigation,2417 outpatient prescriptions and 1698 outpatient prescriptions were respectively selected from some one hospital during Oct.-Dec. 2015 (before improvement and rectification) and Jan.-Mar. 2016 (after improvement and rectification). According to standards,guidelines and references as Prescription Administrative Poli-cy,Prescription Review Management Standard(trial)and drug instructions,irrational drug use and prescription checking and inter-vention skills of pharmacists were compared before and after the implementation of rectification measures as optimizing hospital in-formation system,improving comprehensive skills of pharmacists,strengthening pharmacists'concept,establishing feedback mech-anism. RESULTS:After the implementation of rectification measures,unsuitable indications,clinical diagnosis inconsistent with medication,antibiotics use without indications,unsuitable usage and dosage,unsuitable drug combination and irrational drug use were all decreased,but repeated drug use was increased,without statistical significance (P>0.05). The number of non-standard prescriptions and unsuitable prescriptions checked by pharmacists were decreased,without statistical significance(P>0.05). The in-cidence of checking missing,excessive checking and checking error were all increased from 2.40%,0.99%,3.39% before im-provement and rectification to 0.47%,0.29%,0.77%,with statistical significance(P<0.05). CONCLUSIONS:The improvement and rectification measures of the hospital can improve comprehensive prescription checking and intervention skills of pharmacists. Ir-rational drug use should be further standardized.

Introducing Computer Systems Supporting Works Related to Cancer Chemotherapy and Evaluating Their Effect (the 2nd Report) / 医薬品情報学

  Nagara Medical Center introduced two computer systems that utilized data imputed into electronic medical records.  The first system was used to check cancer chemotherapy prescriptions, whereas the second system was a preparation support system that facilitates precise mixing of anticancer drugs.<br>  The prescription checking system made it possible to easily monitor the dose of anticancer drugs and dosing intervals utilizing data imputed into electronic medical records.  Using this system, the time required for checking was reduced significantly compared to without using the system.<br>  The preparation support system enables converting the dose of anticancer drugs that imputed into electronic medical records to the prepared amount automatically and checking of the amounts of drugs for drug preparations.  Drugs are checked by reading a bar code attached to a vial or ampule in order to check prepared drugs are correct.  The prepared amount of drug is checked by measuring the weight of a syringe used in preparation before and after preparation.  Using the preparation support system, the preparation time required was prolonged significantly compared to that without using the system.  However, questionnaire survey revealed that prolonged time was in the allowable range to ensure safety.<br>  In conclusion, it is considered that the prescription checking system introduced efficient checking of prescriptions, and that the preparation support system introduced an improvement in the accuracy of preparation.

Suggestions and Analysis on the Status Quo of Chinese Prescription-checking Pharmacists / 中国药房

OBJECTIVE:To cultivate qualified prescription-checking pharmacists and to ensure patients'rational drug use. METHODS:The status quo of prescription-checking pharmacists in China was analyzed and some concrete suggestions on how to cultivate qualified prescription-checking pharmacists were made.RESULTS:The phenomena of low educational level and low professional title,lack of professional knowledge and medical knowledge,lack of staff members were widespread in today's Chinese prescription-checking pharmacist professionals.CONCLUSION:The rational drug use can only be realized through being fully aware of the importance of prescription-checking pharmacists,enhancing whose admittance qualifications,working out professional standards for whom,clearly defining their responsibilities,strengthening their cultivation and increasing their numbers.