A Survey of Near-Miss Dispensing Errors in Hospital Pharmacies in Japan: DEPP-J Study-Multi-Center Prospective Observational Study-

The aim of this study was to determine the proportion of near-miss dispensing errors in hospital pharmacies in Japan. A prospective multi-center observational study was conducted between December 2018 and March 2019. The primary objective was to determine the proportion of near-miss dispensing errors in hospital pharmacy departments. The secondary objective was to determine the predictive factors for near-miss dispensing errors using multiple logistic regression analysis. The study was approved by the ethical committee at The Institute of Medical Sciences, University of Tokyo, Japan. A multi-center prospective observational study was conducted in 20 hospitals comprising 8862 beds. Across the 20 hospitals, we assessed data from 553 pharmacists and 53039 prescriptions. A near-miss dispensing error proportion of 0.87% (n = 461) was observed in the study. We found predictive factors for dispensing errors in day-time shifts: a higher number of drugs in a prescription, higher number of quantified drugs, such as liquid or powder formula, in a prescription, and higher number of topical agents in a prescription; but we did not observe for career experience level for clinical pharmacists. For night-time and weekend shifts, we observed a negative correlation of near-miss dispensing errors with clinical pharmacist experience level. We found an overall incidence of near-miss dispensing errors of 0.87%. Predictive factors for errors in night-time and weekend shifts was inexperienced pharmacists. We recommended that pharmacy managers should consider education or improved work flow to avoid near-miss dispensing errors by younger pharmacists, especially those working night or weekend shifts.

[Pressure Compatibility Test of Closed System Drug Transfer Devices for 71 Anticancer Drugs].

Occupational exposure to anticancer drugs may increase the risk of cancer and the risk of miscarriage and stillbirth, and cause other adverse events such as hypersensitivity reactions, skin/mucous reactions, and digestive symptoms. Several studies have investigated the use of closed-system drug-transfer devices (CSTDs) to reduce the environmental pollution by hazardous drugs. However, few reports have verified whether CSTDs contain the hazardous drugs within the vials. The BD PhaSealTM System is a CSTD that is frequently used in Japan. However, the fit of each anti-cancer drug vial has not been investigated. We investigated the fit of 71 major anti-cancer drug vials and protectors released and frequently used in Japan by means of a pressure compatibility test that we developed. The pressure compatibility test involved attaching a three-way stopcock to a Luer lock syringe and attaching an injector in line with the syringe. The pressure tubing was connected to the other side of the three-way stopcock and connected to the pressure inlet of the pressure gauge. The pressure in the anti-cancer drug vial was raised to 100 kPa and connected/disconnected repeatedly. If the pressure fluctuation during the 10th connection was within 6%, it was defined as "no change", and the compatibility of the protector and the vial was evaluated. The median pressure reduction rates at the 10th connection ranged from -1.98% to -4.95%. All drugs surveyed had an error rate within 6%. The BD PhaSealTM Protector was shown to be compatible with the 71 anti-cancer drugs we surveyed.

Development of a simple compatibility inspection method using pressure in a BD PhaSeal™ system and hazardous drug vials.

BACKGROUND: Many reports support the use of closed system drug transfer devices (CSTDs) to protect against exposure to hazardous drugs during their preparation. However, leakage may occur if the CSTD fails to maintain hermeticity when fitted into the vial. Our aims were to devise a measure to prevent HD exposure and to develop a test method to verify CSTD function when a BD PhaSeal™ protector is used in HD preparation. METHODS: We selected the BD PhaSeal™ System, which is the most commonly used CSTD device in Japan. The sealability of the BD PhaSeal™ protector and vial is considered to be due to the hermeticity of the protector and the rubber stopper of the vial. We constructed a protector with a damaged sealing rim and monitored the pressure fluctuation 10 times when the BD PhaSeal™ injector was connected to the pressurized vial. RESULTS: The reduction in pressure of the protector in the group without a damaged sealing rim was 5%, while that in the group with the damaged sealing rim was 84.9%. CONCLUSION: It was suggested that leakage occurred through the gap between the protector and the rubber stopper when using a vial that was not in close contact with the sealing rim. In this study, we developed a test that can be easily used to verify the compatibility of the BD PhaSeal™ protector and a vial in the clinical setting. Thus, when new hazardous drugs are being prepared, these measures can be taken to ensure that the risk of exposure is reduced or eliminated.

Differential impact of fosaprepitant on infusion site adverse events between cisplatin- and anthracycline-based chemotherapy regimens.

BACKGROUND: Fosaprepitant may be associated with infusion site adverse events (AEs), and these adverse events possibly vary according to chemotherapy regimen. PATIENTS AND METHODS: 267 oncology patients who were administered anthracycline- or cisplatin-based regimens were retrospectively studied. Multivariate logistic regression was performed in stratified analyses to evaluate potential regimen-specific effects of fosaprepitant. RESULTS: 41.7% of patients administered fosaprepitant experienced infusion site AEs. On the other hand, only 10.9% of patients administered aprepitant experienced AEs. Multivariate analysis showed a statistically significant overall increased risk of infusion site reaction associated with fosaprepitant (p<0.001), but when evaluated separately according to chemotherapy regimen, this relationship appeared to be largely confined to patients receiving an anthracycline-based regimen (OR=12.95, 95%CI=5.74-29.20). No association was observed among patients on cisplatin-based regimens. A test for interaction was statistically significant (p=0.001). CONCLUSION: Fosaprepitant is associated with an elevated risk of infusion site reaction in patients receiving anthracyclines.

[Cost-effectiveness analysis of 5-HT3 receptor antagonist drugs in cancer chemotherapy].

Recently, ambulatory treatment centers (ATC) are markedly increasingboth in number and scale. It is therefore important to consolidate an efficient therapeutic system. A decrease in both treatment time and waitingtime leads to not only the improvement of the quality of life (QOL) for patients but also the efficient use of personnel and running costs for medical institutions by reducingthe bed occupation rate. In ATC, 5-HT3 receptor antagonists are extensively used for high emetic risk patients. However, their high cost and prolonged treatment causes one of the problems in improvingthe efficiency of the therapeutic system when they are administered by intravenous infusion. Amongthe 4 types of 5-HT3 receptor antagonists (injections) currently available in Japan, azasetron is the only drugthat is not designated as a powerful drug and that can be administered by bolus intravenous infusion. In this study, we investigated azasetron and granisetron from the standpoint of pharmacoeconomics with a simulation model using the results of clinical studies in Japan. Accordingto the results of cost-effectiveness analysis, therapeutic and time costs per patient for azasetron 10 mgand granisetron 2 mg (calculated in consideration of both medical institutions and patients) was 8,219 and 10,193 yen, respectively. This gap was attributable to the time loss due to the difference in administration methods. The result suggests that this time loss is more significant not only for patients but also for medical staff than the loss attributable to the drugcost. Furthermore, the bolus intravenous infusion of azasetron is considered superior to the non-bolus intravenous infusion of granisetron from a pharmacoeconomic standpoint. It is desirable to choose the appropriate administration method of 5-HT3 receptor antagonists in various chemotherapy regimens for the purpose of reducingthe treatment time and promotingthe efficiency of the therapeutic system at ATCs.