Objective: To examine the usefulness of inquiries made by hospital pharmacists.
Methods: This study was conducted a survey about the actual condition of inquiries at 5 hospitals.
Results: The prescriptions subjected to inquiry accounted for 1.5% of the inpatient prescriptions and 0.3% of the injection prescriptions.  In cases of “Incomplete entry in the prescription” for the subcategory of “Question about safety,” drug costs without the impact of pharmaceutical inquiries were calculated on the assumption that the concerned drugs should have been generally prescribed.  Our results showed that the total savings in medical costs were 30,673 yen for the inpatient prescriptions and 159,212 yen for injection prescriptions, which suggested that pharmaceutical inquiries are effective for saving medical costs for either type of prescriptions.  In the case of patients in whom adverse drug reactions (ADRs) might have occurred without prescription changes, medical cost savings realized by preventing ADRs were estimated using the Diagnosis Procedure Combination/Per-Diem Payment System (DPC/PDPS).  Our results showed that the savings were 1,428,710 yen for inpatient prescriptions (6 patients), which indicated that a large amount of medical costs was saved.
Conclusions: Our results suggested that similar to pharmaceutical inquiries made by community pharmacists, those made by hospital pharmacists not only result in the proper delivery of drug therapy but also are useful in terms of medical economics.

A 30-year-old woman who had no specific symptom was diagnosed with Turner syndrome at the age of 6 years. Subsequently, she was followed up at a hospital. However, she stopped going to the hospital when she was 18 years old. At 30 years of age, she underwent examinations involving echocardiography and enhanced chest CT at a hospital, which revealed severe aortic valve regurgitation and extreme dilatation of the aortic root. We performed the Bentall procedure through a median sternotomy following which she had an uncomplicated postoperative course. Aortic root enlargement increases the risk of aortic dissection in patients with Turner syndrome. However, no aortic events occurred before the surgery in this case. We considered the reason was related to the mosaic karyotype of this case.

A 39-year-old man with fever and dyspnea from 3 days earlier was taken to the emergency room. He was diagnosed with infective endocarditis because echocardiography showed a mobile 10 mm-sized vegetation on the aortic valve and severe aortic regurgitation. Acute coronary syndrome was negative because the tests at the first visit did not show an increase in myocardial deviation enzymes or a decrease in wall motion. However, his hemodynamics deteriorated during the same day, so he underwent emergency surgery. The left and right leaflets and the right aortic annulus were highly destroyed, and the aortic annulus was reconstructed with his pericardium and the valve was replaced by a mechanical valve. After declamping of the aorta, the wall motion of the left ventricle was extremely reduced, and the cardiopulmonary bypass(CPB) was not able to be withdrawn. Since the left anterior descending (LAD) coronary artery may have been occluded by vegetation, we added bypass surgery to the LAD under cardiac arrest using a saphenous vein graft. After the bypass surgery, the wall motion of the left ventricle improved, and we were able to withdraw the CPB. Though he developed a cerebral infarction as a complication and required long-term rehabilitation, he was able to be discharged from the hospital 74 days after the operation. We evaluated the coronary arteries after his discharge and found an occlusion that was thought to be due to vegetation scattered in the LAD. No preoperative coronary artery evaluation was performed, however, the graft was anastomosed to the distal side of the LAD occlusion. Currently, 3 years and 2 months have passed and the infection has not recurred.