The Effectiveness of Washing Clothing Contaminated With Cyclophosphamide: A Pilot Study.

BACKGROUND: Measures to prevent exposure to anticancer drugs mitigate health hazards for caregivers, family members, and healthcare workers caring for patients with cancer. Previous studies have reported that anticancer drugs were detected on the linens of patients receiving chemotherapy. OBJECTIVES: This pilot study investigated the effectiveness of the washing methods recommended by Japanese guidelines for linens contaminated with cyclophosphamide (CTX). METHODS: This study used 15 shirts contaminated with 10 mg of CTX divided into three study groups washed with or without detergent, with or without an additional clean shirt. The CTX level on each shirt was measured after washing. Residual CTX levels on the shirts were compared to the measurable level of 1 ng/cm2 as a criterion for evaluating efficacy. FINDINGS: Washing a garment twice, as recommended in the Japanese guidelines, is effective in removing CTX contamination from clothing with or without detergent. However, contaminated garments should be washed separately from uncontaminated clothing.

Validation of quality indicators for evaluating geriatric pharmacotherapy services in primary care: a mixed methods study.

OBJECTIVE: To assess measurement properties of 121 face and content validated quality indicators (QIs) for medication safety in geriatric pharmacotherapy in primary care. DESIGN: A mixed methods study: a 6-month observational study in primary care (July-December 2020) and in-depth semistructured online interviews with participants (February-March 2021). SETTING: Sixty community pharmacies in Japan. PARTICIPANTS: Patients aged 75 years and older who were regularly taking six or more prescription medicines for ˃4 weeks were eligible. The observational study included 457 patients. The interviews were undertaken with 26 community pharmacists, including pharmacy managers and owners. PRIMARY AND SECONDARY OUTCOME MEASURES: Five measurement properties of QIs (applicability, improvement potential, acceptability, implementation issues and sensitivity to change) were evaluated. A web application was developed for data reporting and data visualisation. RESULTS: This study showed that 53 QIs met the measurement properties of applicability, improvement potential, acceptability and implementation issues. Of 53 QIs, 17 also had a high sensitivity to change. Interviews identified eight themes (indicator characteristics, web application, policy, patient, time, competence, pharmacy administration and collaboration) in relation to the consequence of implementation of QIs. CONCLUSIONS: A set of 121 QIs for geriatric pharmacotherapy was field tested for their five measurement properties. This QI set can be used to identify patients who may benefit from clinician reviews of their medicines. These QIs may be applied at different levels within the healthcare system: patient, pharmacy, regional and national levels. Further mechanisms to automatically collect and report data should be established to facilitate sustainable quality improvement initiatives.

Duration of sweat cyclophosphamide excretion in patients undergoing a conditioning regimen of high-dose cyclophosphamide for hematopoietic stem-cell transplantation.

PURPOSE: To investigate the duration of cyclophosphamide (CPA) excretion in the sweat after administration when receiving high-dose CPA therapy as a conditioning regimen for hematopoietic stem-cell transplantation (HSCT). METHODS: Shirts and pillowcases samples (changed once a day) from 12 patients, categorized as groups 1 (n = 6), 2 (n = 4), and 3 (n = 2), receiving high-dose CPA therapy were collected, sealed, stored at 4°C, and mailed to an analytical facility for CPA estimation using LC-MS/MS. CPA was administered intravenously at a dose of 60 mg/kg on days 1, 2 (closed-system delivery for group 3), and samples were collected during days 1-4 (groups 1,3) or days 1-9 (group 2). RESULTS: CPA was detected in all 126 shirts and pillowcases. In 9 patients, excluding 1 patient who had fever during the study period and group 3 patients, the mean (range) rate of CPA excretion in sweat was 0.03% (0.01-0.12%). The mean CPA excretion in 9 patients adjusted for body weight was 19.9 µg/kg on day 1 and 0.3 µg/kg on day 4. CONCLUSIONS: This study showed that CPA was excreted for an extended duration in the patient's sweat, receiving a high-dose CPA therapy as a conditioning regimen against HSCT.

[Promotion of Child Health and Development Care in Pharmacy Education].

Japan is simultaneously facing both an aging society and low birth rates, causing a continuing population decline. To cope with the declining birthrate, it is urgent to make child health and development medicine a natural accompaniment to all life stages. As pharmacists and pharmacies have a major role to play in this, it is necessary to position child health and development medicine in training for student pharmacists. On the other hand, student pharmacists are young adults who may be directly involved in child health and development, and this is not only an issue for women, but also needs to be understood by men. This symposium provides an opportunity to build a consensus on the role of pharmacists in the increasingly diverse and sophisticated support for child development in terms of pharmaceutical education.

Development and consensus testing of quality indicators for geriatric pharmacotherapy in primary care using a modified Delphi study.

Background Polypharmacy is associated with an increased risk of adverse drug events in older people. Although national guidance on geriatric pharmacotherapy exists in Japan, tools to routinely monitor the quality of care provided by community pharmacists are lacking. Aim To develop a set of quality indicators (QIs) to measure the quality of care provided by community pharmacists in improving geriatric pharmacotherapy in primary care in Japan, using a modified Delphi study. Method The development of QIs for the Japanese community pharmacy context followed a two-step process: national guidance review and consensus testing using a modified Delphi study. The latter involved two rounds of rating with a face-to-face meeting between the rounds. Ten experts in geriatric pharmacotherapy in primary care were recruited for the panel discussion. QIs were mapped to three key taxonomies and frameworks: the Anatomical Therapeutic Chemical (ATC) classification system, problems and causes of drug-related problems (DRPs) taxonomy and Donabedian's framework. Results A total of 134 QIs for geriatric pharmacotherapy were developed. This QI set included 111 medicine specific indicators, covering medicines in 243 third-level ATC classifications. QIs were classified into the problem of treatment safety (80%) and causes of drug selection (38%) based on validated classification for DRPs. In Donabedian's framework, most QIs (82%) were process indicators. There were no structure indicators. Conclusion A set of 134 QIs for geriatric pharmacotherapy was rigorously developed. Measurement properties of these QIs will be evaluated for feasibility, applicability, room for improvement, sensitivity to change, predictive validity, acceptability and implementation issues in a subsequent study.

Developing and testing a set of quality indicators for pharmacist home visit services: A mixed methods study in Japan.

OBJECTIVE: Quality indicators (QIs) are an important mechanism by which health services can be evaluated. We aimed to develop a set of QIs for pharmacist home visit services and assess their measurement properties. METHODS: A three-step procedure was applied: (1) Selection of existing content-validated QIs from the international literature and the development of QIs based on national guidelines and home healthcare professionals' opinions; (2) Expert panel consensus of a preliminary set of QIs using the RAND/UCLA Appropriateness Method; (3) Field testing to evaluate their measurement properties (feasibility, applicability, improvement potential, discriminatory capacity, sensitivity to change, acceptability and implementation issues) followed by exploratory semistructured interviews in Japan. RESULTS: Fifty-two preliminary QIs were prepared and 45 were judged as "appropriate"by the expert panel. Sixty-one community pharmacies were recruited to this study with 41 contributing QI data monthly over the 6-month period. Field testing showed that 20 QIs met six measurement properties (ie, feasibility, applicability, improvement potential, discriminatory capacity, acceptability and implementation issues). Nine of these QIs also had high sensitivity to change. Additionally, interviews identified that the main positive impact on practice of using QIs was the early detection of causes of drug-related problems but a negative impact was decrease of pharmacists' motivation. Auto extraction of QIs was seen as a major facilitator, given the time taken to manually extract QI data. CONCLUSIONS: A set of QIs for pharmacist home visit services was rigorously developed and tested. This QI set may be useful in evaluating the quality of such services.

[Advanced Pharmaceutical Management Functions in Home Pharmaceutical Care].

In 1994, community pharmacists first started patient-visiting services under health insurance coverage. There are a wide variety of home-care patients for whom pharmacists provide care. They include elderly patients with chronic disease, pediatric home-care patients with or without special needs, patients with dementia, cancer patients receiving palliative care, and others. Pharmacies engaging in home pharmaceutical care should establish an adequate system in terms of the following aspects: 1) number of pharmacists; 2) availability of a sterile dispensing room; 3) stock of medical narcotics; and 4) stock of medical supplies. Nevertheless, it is impossible for every pharmacy to provide home pharmaceutical care in the same fashion, since many factors, such as the vision of the pharmacy proprietor, business size, experience and expertise of pharmacists, and regional characteristics vary. A survey of 149 pharmacies authorized to dispense injection drugs in Tokyo clarified the profile of pharmacies specializing in home pharmaceutical care based on the number of patients served, number of patients receiving at-home end-of-life care, amount of medical narcotics in stock, etc. The results revealed that specialized pharmacies were required by home-care patients who were highly dependent on medical treatment. In the future, as the number of home-care patients with high medical treatment dependence is expected to continue rising, an evaluation of pharmacies meeting the needs of these patients should be undertaken from the viewpoint of advanced pharmaceutical management functions.

Exploring the factors influencing the quality of "Health Support Pharmacy" services in Japan: Perspectives of community pharmacists.

BACKGROUND: Internationally, community pharmacists play a key role in public health services. In Japan, a new system called Health Support Pharmacy (HSP) was introduced in 2016, to promote responsible self-medication with non-prescription medicines and increase awareness of public health activities provided through community pharmacies. The number of HSP services provided has been increasing; however, the service quality varies depending on pharmacies and/or pharmacists. Thus, it is important to identify factors that influence HSP service quality. OBJECTIVE: To identify factors that can impact on the quality of HSP services provided by community pharmacists in Japan. METHODS: In-depth semi-structured online interviews were conducted with twenty-four community pharmacists from across Japan. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. All themes identified were deductively categorised into 3 domains using Donabedian's framework of structure, process and outcome. RESULTS: Participants identified 8 key themes and 23 sub-themes pertaining to the quality of pharmacy public health services. For the structure domain these were: adequate resources, professional expertise, and policy and procedures. For the process domain these were: provision of individual services, provision of community health education and other events, and collaboration with other professionals. For the outcome domain these were: impact on individuals and the general public, and impact on other professionals. CONCLUSIONS: This study identified factors which can impact HSP service quality by community pharmacists in Japan. Whilst the major themes identified align with those reported in other studies pertaining to expanded roles for community pharmacists, this study also identified findings which appear to be unique to the Japanese context. These findings, based on Donabedian's framework, may be used to better understand the scope and quality of HSP services delivered in Japan.

[Advanced Pharmaceutical Management Functions in Home Pharmaceutical Care].

Patients who receive home visits by pharmacists show a wide range of diseases.The patients are mainly elderly people with chronic diseases, children with some diseases or disabilities, and cancer patients receiving palliative care.Such patients request various pharmaceutical care at home from pharmacies.Pharmacies are essentially medical facilities and they must receive prescriptions from all patients, but depending on each pharmacy, there are few cases of a pharmacy refusing to receive prescriptions.Pharmacies participating in home pharmaceutical care need to establish a system incorporating 1 ) sufficient number of pharmacists, 2 ) pharmacy aseptic unit, 3 ) stockpiling of medical narcotics, and 4 ) stockpiling of medical supplies.However, because individual pharmacies have different situations, such as the intention of the founder, size of the facility, and experience and regionality of pharmacists, it is impossible for all pharmacies to participate in home pharmaceutical care in the same way.An increasing number of home patients with high dependence on medical care is expected in the future.For these patients, pharmacists need high clinical experiences, and at the same time, the burden on pharmacies to stockpile medicines will increase.Therefore, evaluation of pharmacies for home care patients with high dependence on medical care should be considered as an advanced pharmaceutical management function.

[Construction of a Home-Visiting System as a Family Pharmacy].

"The Vision for Patient-centered Pharmacies," published by the Ministry of Health, Labour and Welfare(MHLW)in October 2015 specifies three functions of family pharmacies, including home medical care. In 1994, home-visits by pharmacists officially began; however, before then, we had already visited patients whose medications and life situations were of concern, at their homes. Based on that experience, as we were planning to undertake home-visits after their institutionalization, we conducted a study of a system that would promote home care using pharmacists handling various duties, including prescriptions and health consulting. Considering the pharmacists' years of experience and work shifts, efficiency/productivity, and the role of a family pharmacy, we developed a home medical care support system by allocating two pharmacists to each patient's home. Thus, we concluded that if the entire pharmacy would be involved in home-visiting services along with outpatient prescription dispensing services as part of continuous follow-up of patients from hospital visits to home care, the pharmacy would eventually serve as a family pharmacy in the community.

[Usual Relationship to Support Sudden Discharge-Coordination Starting from Pre-Discharge Support Considered through a Case Report of Supporting a Patient with ALS].

Due to promotion of home medical care, the number of patients who highly depend on medical care is increasing. Therefore, the role of pre-discharge conferences where a care manager is involved starting from pre-discharge support has become more important. In addition, in a usual relationship, cooperation between the hospital staff and the home care support team is crucial. Among home care workers, the word "coordination" has generally been used for a long time to prepare for the transfer of patients from a hospital to home. However, there is a considerable gap between healthcare and caregiving; consequently, it is difficult to actually create coordination between them because the terms to be used and the contents mastered by personnel in each field are different. In this paper, we report a case of successful coordination for smooth transfer of a patient with ALS from a hospital to home, by creating a homecare team in which all members work together based on the information obtained from a hospital social worker.

[Current State of Process of Dispensing Prescription for Pediatric Patients Who Need Home Visiting for Intervention for Pharmaceutical Management].

Medical advances have made it possible to save lives of children with severe refractory diseases. As a result, the number of children who need continuous medical care at home has increased. However, there are concerns that many pharmacies are not actively involved in, because the dispensing fee does not match their prescriptions, which are very complicated and contain some high-risk medicines. We analyzed the burden of dispensing prescribed medicines so that we can quantitatively discuss from prescription contents. The essence of the burden of a pharmacy regarding home medical care for children is to cover the transportation of heavy pharmaceuticals and the combination of multiple medication including high-risk medicines and lack of pediatric drug formulations with the efforts of the on-site pharmacist. It became clear that the pharmacist's objective work supports pediatric pharmacotherapy.

[Mindset for Pharmacists as an Expert of Pharmacotherapy-Case of Home-Care Rheumatoid Arthritis Patients with Multiple Diseases].

The number of older adult patients with rheumatoid arthritis(RA)is increasing. As older adult patients tend to have multiple diseases requiringmedications, they are likely to experience side effects from the decline in their physiological functioning. In addition, suppression of disease activity leads to a decline in ADL in the case of patients livingalone, even leadingto difficulties in livingat home. In the 3-years clinical course on older adult RA patients livingalone with multiple diseases, we show the mindset that community pharmacists must have for three events(namely, hypoalbuminemia, chronic heart failure, and dehydration)in which inflammation influences medicinal or side effects.

Home healthcare professionals' perspectives on quality dimensions for home pharmaceutical care in Japan.

AIM: In Japan, home pharmaceutical care (HPC) has recently been provided to home-bound older adults who have difficulties in accessing a community pharmacy, for regular medicine supplies and medication management. Although the number of HPC services provided has increased, HPC is not always carried out by clinically well-trained pharmacists, causing differences in the quality of HPC provided. The aim of the present study was to establish the quality dimensions of HPC (i.e. components that impact the quality of HPC) from the perspectives of home healthcare professionals. METHODS: Semistructured interviews and focus groups were carried out with nine home healthcare teams, comprising 61 multidisciplinary professionals including pharmacists, doctors, nurses, care managers, home helpers, medical social workers and other relevant stakeholders involved in home healthcare. Participants' responses were analyzed using thematic analysis. Identified themes were then categorized using Donabedian's framework (structure, process and outcome). RESULTS: Nine themes and 27 subthemes emerged, including: structure (pharmacist factors, pharmacy factors and external factors), process (before HPC, during HPC, after HPC and outside of HPC) and outcome (impact on patients and impact on other healthcare professionals). CONCLUSION: This study has identified quality dimensions of HPC from multidisciplinary home healthcare professionals' perspectives. These findings might be used to inform aspects of HPC that require improvement. In order to evaluate the quality of HPC, a set of indicators based on the identified quality dimensions could be developed. Geriatr Gerontol Int 2019; 19: 35-43.

[Team Collaboration in Home Medical Care to Support Patients at the End-of-Life - Review of Service Personnel Meeting on Discharge Day].

Due to the rising number of patients at the terminal stage or with high dependence on medical care, the cooperation of 2 teams, the hospital discharge support team and the home support team, has become very important. The recent spread of the Internet has enabled both patients and their families who have chosen home care to obtain a wide range of information about home services, as well as diseases, and form a picture of what will happen. However, there are actually many cases in which patients and families find that things are not as they imagined, and they are uneasy and unsure of what to do. Here, we report a case in which the mismatch between the patient's and family's expectations created an unsatisfactory care situation.

[Efforts of Deprescribing Drugs and Its Achievements in Institutionalized Individuals].

Recently, the combined use of multiple drugs for coexisting multiple diseases in elderly patients has become a problem. In facilities for elderly persons, pharmacists contribute to the intervention and optimization of prescriptions. However, the procedures have been conducted smoothly in only a few facilities. We established five procedures for prescription intervention by pharmacists and implemented these interventions in 80 institutionalized individuals. The total results over 2 years(January 1, 2015 to December 31, 2016)revealed 118 cases of prescription proposals from pharmacists and a reduction of 2,411,937 yen in medical expense. The purpose of prescription proposals from pharmacists is to reduce burden on patients by optimizing prescriptions, but not to reduce the number or dose of drug. In doing so, it was important to hear patients' opinions on medical care. Patient-centered prescription proposals from pharmacists are considered to have improved the quality of medical care and may enable the promotion of prescription intervention.

[Introduction of PBPM and Its Effects for a Home Care Support Clinic].

Medical teams have been promoted in home care. It is possible for pharmacists who are part of a multidisciplinary team to maintain safety and improve the quality of medical care. Protocol-based pharmacotherapy management(PBPM)is recommended for cooperation between the pharmacist and the doctor in the management of pharmacotherapy. In order to introduce PBPM, it is necessary for the pharmacist and the doctor to cooperate and to extract the problems in community medicine. In this study, the clinic pharmacist examined the problem of unnecessary inquiries and proposed PBPM. He suggested that to smoothly introduce PBPM, a protocol creation committee should be set up and an explanation of PBPM should be provided to the Community Pharmacist Association. As a pilot study, we created 5 protocols at Doctor GON Kamakura Clinic with the cooperation of 8 pharmacies. As a result, it became possible to reduce unnecessary inquiries by 46%. Careful coordination is necessary in order to introduce PBPM at clinics and community pharmacies. Moreover, a clinic pharmacist is able to facilitate the introduction of PBPM in the role of coordinator.

[Role of Pharmacists in the Care of Pediatric Patients Needing Home Visiting Intervention for Pharmaceutical Management and Their Life Depending on Medical Care].

Medical advances have made it possible to save lives of children with severe refractory diseases. As a result, the number of children who need continuous medical care at home has increased. However, currently, few medical personnel of both medical institutions and pharmacies are aware of home visiting intervention for pharmaceutical management. Home visiting intervention should be utilized more for severely impaired children who are highly dependent on medical care to effectively reduce the nursing care burden of the family and to secure pharmaceutical supply path.

[Case Study - A Successful Cooperation of Clinic Pharmacist and Pharmacies in Home Palliative Care with PCA Pump].

To make a good end at home and provide good palliative care for patients with cancer are urgent issues in Setagaya ward, as shown by certain statistics. Medical opioids are greatly needed for palliative care; as patient controlled analgesia(PCA) develops, it can lead to decisions by patients and their families to receive end-of-life care at home because the patient can choose to receive the same advanced palliative care received at the hospital. With in-home palliative care, given the rapid change in the medical condition of the patient and the sentiment of the family, the role of pharmacists is to quickly and reliably supply the pharmaceuticals and medical equipment that doctors need. The following are important in order to enable this; 1 ) a pharmacy stocked with medicalopioids in accordance with needs, 2 ) a pharmacy with a system that can provide support quickly, 3 ) the presence of people who understand the area of resources, and 4 ) a constant face-to-face relationship. The "Sakura-HOPPS(Sakurashinmachi Homecare Pharmacists PartnershipS)"is a group intended to provide exchange and cooperation of pharmacists beyond the framework of organizationalaffil iation, and authors hope to encourage the participation of increasingly more pharmacists to develop a close-cooperation system of acute care hospitals and community medical/home care.