Objective: To prevent the mis-prescription of drugs that differs from the true intention, it is important to understand the factors underlying mis-prescription. In this study, we focused on drug prescription errors caused by drug name similarities and compared drug dispensing errors by pharmacists to clarify their characteristics.Methods: We extracted cases of drug prescription and dispensing errors caused by drug name similarity from "near-miss events from pharmacies" reported from March 2020 to October 2022, which were curated by the Japan Council for Quality Health Care. By comparing the characteristics of pairs of "drugs intended to be prescribed or dispensed" and "drugs that were mis-prescribed or misdispensed" (called as drug name pairs), we analyzed trends in drug prescription errors caused by drug name similarity. Specifically, we evaluated drug name similarity (calculated using m2-Visually Weighted Head and Tail-weighted Fragmentary Pattern-Based Measure; m2-vwhtfrag), the number of initial common characters, and drug efficacy similarity (evaluated by drug efficacy classification number) in drug name pairs and assessed their occurrence among drug prescribing and dispensing error cases.Results: From the "near-miss events from pharmacies," 234 cases of prescription errors and 152 cases of dispensing errors caused by drug name similarity were extracted. Drug prescription errors exhibited higher drug name similarity (i.e., higher values of m2-vwhtfrag) and more initial common characteristics than drug dispensing errors. In contrast, drug prescription errors showed a lower consistency in drug efficacy similarity.Conclusion: In this study, we found that prescription errors by physicians were more likely to be influenced by drug name similarity and less likely to be influenced by drug efficacy similarity compared to the dispensing errors by pharmacists. These findings are reasonable, considering the characteristics of the prescription ordering systems.

Objective: Contrast media side effects range from minor ones such as itching and vomiting to life-threatening ones such as hypotension and loss of consciousness. The purpose of this study was to determine how contrast media side effects are actually managed in hospitals nationwide, as well as to identify opportunities for the pharmacy department to be involved in contrast media administration, and pharmacists’ awareness of the risk of contrast media side effects. Methods: A self-administered, unmarked questionnaire survey was conducted in the pharmacy departments of 2,000 hospitals nationwide. The survey asked about the existence of internal rules and manuals regarding contrast media at each facility, how to deal with patients at risk for side effects, opportunities for intervention with patients by the pharmacy department, and opportunities for discussion among pharmacists and other professionals regarding the administration of contrast media. Results: Of the 2,000 facilities, 96 responded to the questionnaire, among which 69 had internal regulations or manuals. In those with manuals, the manuals stipulated measures such as not administering contrast media or administering premedication in the case of patients with a history of contrast media side effects. In facilities where the manual recommended premedication, it was found that premedication was administered in both inpatient and outpatient settings. Regarding the role of the pharmacy department, it was found that intervention in all items related to risk factors for adverse drug reactions was achieved for only about 10% of the outpatients. Conclusion: This study revealed that many facilities are involved in the management of contrast media side effects. The results indicate that there is scope for pharmacy departments to intervene more proactively in outpatient settings to ensure appropriate contrast media use in the future.

Objective: The collection and utilization of adverse drug reaction (ADR) reports are essential in pharmacovigilance activities. Healthcare professionals, especially pharmacists, are required to report ADRs to the regulatory authorities in Japan. The ability of pharmacists to identify ADRs, assess causality and severity, and submit ADR reports is of utmost importance. This study aimed to investigate the current status and challenges of education regarding ADR reporting in pharmacy schools in Japan. Design: A cross-sectional survey. Methods: A self-reported questionnaire was conducted among faculty members of 77 pharmacy schools in Japan to assess the implementation of ADR reporting system education. A separate survey was conducted among hospital and community pharmacists to understand ADR reporting-related training provided during practical training. The questionnaire included items on implementing ADR-related lectures and practical training, characteristics and innovations in such education, and opinions on ADR reporting education. Results: Responses were obtained from 48 pharmacy schools (response rate: 62%). The implementation rates for lectures on the ADR reporting system and ADR causality assessment were 94 and 83%, respectively, typically conducted in the 3rd or 4th year. However, the implementation rate for training on completing ADR reporting forms was only 38%, with 61% of these schools providing practical exercises. The survey of hospital and community pharmacists (n=22) revealed that 82% provided training on completing ADR reporting forms, often using case studies or simulated scenarios. Conclusion: The survey found that pharmacy schools offer lectures on ADR reporting, but there isa need for practical training to improve pharmacists’ ability to report ADRs. To enhance pharmacists’ skills in this area, there should be more collaboration between schools and training sites, and comprehensive educational programs and lifelong learning opportunities should be developed.

Objectives: A refill-prescription system startedin April, 2022 in Japan. Refill-prescriptions can be usedrepeatedly, but pharmacists are required to check patients' medication and determine whether refills are appropriate. This study aimed to clarify the actual status of community pharmacies' treatment of prescription refills and pharmacists’ concerns about them.Design: Questionnaire survey.Methods: A self-administered questionnaire survey was conducted for pharmacists at community pharmacies from June to July, 2022, shortly after the refill-prescription system was launched, focusing on handling of prescription refills in community pharmacies, and concerns and challenges about refill-prescriptions.Results: Responses were obtainedfrom 377 pharmacists in 34 prefectures throughout Japan. Among them, 30.8% had received refill-prescriptions. Many pharmacists checked medical histories, changes in patients' symptoms, and medication and medical examination status when determining the appropriateness of refills, but few reviewed past laboratory values or laboratory values measuredby patients themselves at the time of their pharmacy visit. Moreover, 34.8% of the pharmacies had internal rules for dealing with refills, and 39.8% had equipment to measure laboratory values. Many pharmacists were concerned about how to share patients’ information with other pharmacies. Challenges that were identified included “Determining whether the refill is appropriate for the patient” and “Establishment of a pharmacy system to receive refill-prescriptions”.Conclusion: This study clarified the actual status of community pharmacies handling of prescription refills, and pharmacists' concerns or challenges about them. Potential improvements include increasing the number of devices that can measure laboratory values at pharmacies, improving home-use measuring devices, creating guidelines to determine the appropriateness of prescription refills and improving pharmacists' skills.

Objective: Adverse reactions are sometimes induced by contrast media used for medical imaging and can be life-threatening. Thus, appropriate management is important for patient safety. The purpose of this study was to clarify the actual management of adverse reactions induced by contrast media in hospitals, the opportunities for intervention by hospital pharmacy departments and the attitudes of hospital pharmacists regarding the risk of adverse reactions.Methods: A self-administered questionnaire survey was conducted in the pharmacy departments of 16 hospitals (approximately 200 to 1,000 beds) located in the Tokyo metropolitan area of Japan. The survey asked about the presence or absence of internal rules or manuals regarding contrast media administration at each hospital, the management status of patients with risk factors for adverse reactions, the opportunities for interventions by pharmacists, and the opportunities for discussion regarding contrast media administration among pharmacists and other professionals.Results: Of the 16 hospitals, 10 responded to the questionnaires, and 7 of them had internal rules or manuals. These rules or manuals stipulated actions such as “do not administer contrast media” to patients with risk factor(s) for adverse reactions. For inpatients, there were opportunities for pharmacist interventions, such as drug management and guidance services and initial interviews upon hospital admission. However, for outpatients the opportunities for interventions were limited. At 5 of the 10 hospitals, pharmacists discussed contrast administration with physicians, radiologists, and other healthcare professionals.Conclusion: The present study reveal that many hospitals take great care in deciding on the administration of contrast media to patients at risk of adverse drug reactions. Our results indicate that the limited opportunities for “outpatient intervention" is an issue in the hospital pharmacy department's participation for proper use of contrast media.

Objective: Pharmacists at insurance pharmacies play an important role in the pharmaceutical care of outpatients receiving cancer chemotherapy. This study aimed to clarify the actual status of insurance pharmacies' involvement in cancer chemotherapy and associated issues, based on an analysis of prescription inquiries made to doctors by pharmacists at an insurance pharmacy.Design: This was a retrospective observational study.Methods: The data was collected in one insurance pharmacy, which received prescriptions mainly from Gunma Prefectural Cancer Center. Among 2, 258 inquiries recorded from January 2015 to May 2018, inquires related to oral anticancer drugs or supportive care medicine were extracted. The frequency of inquiries for each item, or the frequencies of factors that lead to inquiries were calculated. Inquiries considered to have potentially led to the prevention or avoidance of adverse drug reactions (ADRs), so-called “preavoidance” inquiries, were also extracted.Results: Four hundred and forty inquiries related to 20 oral anticancer drugs were included in the analysis. The prescriptions were changed after 92.7% of all prescription inquiries. Prescription inquiries for drugs with rest periods were more frequent than those for drugs without rest periods. The most common inquiries were about the medication schedules stated on the prescription, followed by inquiries about supportive care drugs. Approximately 60% of the pharmacy inquiries were related to“pre-avoidance”inquiries. Most of the pre-avoidance inquiries concerned prevention of ADRs, though these inquiries also contributed to“reduction or avoidance of mental anxiety”. The prescription inquiries were triggered by information collected by pharmacists from patient interviews and from medication histories.Conclusion: Our findings suggest that inquiries to the prescribing doctors by pharmacists at insurance pharmacies contribute significantly to the appropriate use of anticancer drugs.

A 6-year pharmaceutical education system was initiated over a decade ago in Japan because highly skilled pharmacists are needed by communities and hospitals. The current national examination for pharmacists consists of three sections, and its primary purpose is to assess the ability of students to apply the pharmaceutical knowledge they attained at university or college to real-world practice in medical care. We aimed to examine the attitudes of clinical pharmacists working in community pharmacies and hospitals regarding the practical section of the national examination for pharmacists. An online survey was conducted between November 2018 and January 2019. The results of this survey showed that 15 out of the 50 total pharmacists surveyed attempted to answer or skimmed through some questions from the practical section of the 103rd national examination for pharmacists. On the contrary, a little less than half of the pharmacists disregarded the examination content. The participants answered 10 questions extracted from the 103rd national examination that were related to real-world practice. They considered most information to be necessary knowledge in clinical situations, e.g., that concerning drug and food interactions. Furthermore, self-medication and treatment at home that are and will be increasingly required for pharmacists in the future were considered relevant and important.

Objective: In order to ensure the safety of nursing home residents, it is very important to implement appropriate assistance to ensure compliance with necessary medication. The purpose of this study is to identify issues and to plan solutions for medication assistance.Design: We conducted a workshop involving care workers (CWs), nurses and pharmacists together.Methods: Using the KJ method, participants extracted problems related to medication assistance and planned solutions in a mixed group of CWs, nurses and pharmacists. Questionnaire surveys were conducted for the participants before, immediately after, and 3 months after the workshop.Results: A number of important and urgent issues related to medication assistance were identified. There were differences in the recognition patterns of the importance and urgency of the issues among the three categories of participants. In addition, many possible solutions were proposed. Among these solutions, 25% had been implemented by at least two participants. More than 75 % of participants felt that their awareness of the value of cooperation in medication assistance had been improved by participating in the workshop.Conclusion: These results suggest that a workshop with a group of CWs, nurses and pharmacists in one place is a useful approach for extracting problems and planning effective solutions related to cooperation in medication assistance.

Objective:Marketing specialists (MSs) from pharmaceutical wholesalers might shore up post-marketing surveillance (PMS) by pharmaceutical manufacturers. The purposes of this study were as follows: to research problems in PMS found by market specialists, to find solutions for these problems, and motivating MSs to work on PMS. Methods: We conducted a workshop with 12 MSs, who were already working on PMS operations. Participants were divided into three groups. Each group discussed problems with their PMS operations using the KJ method, discussed the potential solutions for the problems, and finally presented them in a plenary debate session. Questionnaire surveys were conducted for the participants before, immediately after, and 6 months after the workshop. Results: This workshop revealed two crucial and urgent problems on PMS faced by MSs: lack of feedbacks to clinical site and lack of publicity of the significance of PMS by MSs. Several solutions were suggested: browsing system of collected information, publication of the stages of improvement in pharmaceutical preparations and packaging, and distributing leaflets about PMS by MSs. In addition, this workshop conferred a positive influence on the participants: in the post-workshop questionnaires, most of the participants answered that they could well understand the problems (92%) and the solutions (75%) on PMS, and that they could improve their attitudes toward PMS operations (83%). . Conclusion: This workshop was quite effective for most of the participants in searching the problems, considering the solutions, and improving their attitudes. Organization of several such workshops might result in better PMS by MSs.

Objective: The revised Pharmaceutical Affairs Act that came into force in June 2009 prohibits the sale of nonprescription drugs via mail.  However, as a provisional measure, regular users and inhabitants of remote islands who do not have access to pharmacies or drug stores are allowed to purchase nonprescription drugs via mail until the end of May 2013.  This study involves a survey on the purchasing of nonprescription drugs by Internet-illiterate inhabitants of the remote Goto Islands, Nagasaki Prefecture, Japan.
Methods: Our process began with the distribution of questionnaires via mail to inhabitants of the remote Goto Islands, of whom 3,819 were randomly selected.  The responses were sent between January 22 and February 26, 2011.  We analyzed problems presented by 522 inhabitants who were Internet-illiterate.
Results: The results revealed that 57.3% of the respondents living on large islands—with pharmacies, drug stores, and pharmacists— (e.g., Fukueshima) and 85.3% of respondents living on small islands scattered around large islands—with none of the abovementioned amenities— (e.g., Maeshima) were Internet-illiterate.  Additionally, a majority of the respondents (more than 80%) felt no need to purchase nonprescription drugs over the Internet.  However, considering that a handful of these inhabitants do, or will at some time need to purchase nonprescription drugs over the Internet, we strive to establish an optimal system for supplying medications to these Internet-illiterate inhabitants.
Conclusion: Community pharmacists need to establish close relationships with the Internet illiterate (particularly those living on small islands) and promote the overall appropriate use of medicinal products.