Pharmacy Division
Introduction
On November 1st 1998 we began a Japanese DRG (Diagnosis Related Groups) / PPS (Prospective Payment System) in ten National Hospitals. In American DRG/PPS, health expenditures, including drug costs, are being reduced. Thus, it seems that we examine conversion of brand drug into generic drug after this. The Ministry of Health and Welfare will begin to reevaluate generic drugs and will compile an "Orange Book" for Japan, since evidence based-medicine (EBM) in health service has recently become more popular, it is important for our pharmacy to examine adoptive generic drugs that were evaluated by various studies.
Routine Activities
Pharmaceutical care for patients has become the fundamental work of pharmacists at the National Cancer Center Hospital East. In the thoracic ward, a pharmacist visits the patient to explain the medicine, such as the name, dosage, site of action, time of administration, etc., so the patient will understand the medicine he or she is taking. At the palliative care unit (PCU), the dose and method are explained, particularly for those scheduled for discharge, because it is important for them to fully understand the medication regimen to be used at home in order to maintain their physical and mental well being. After discharge from the hospital, these patients are followed up with pharmaceutical care at the outpatient clinic. As a matter of course, we also provide such care for any other outpatients, if requested.
As of October 1997 we have been using a printing medication packet machine so the nurse can make sure of the drug name and so the patient will know the name also.
Aseptic preparation of intravenous hyper-alimentation (IVH) for both in- and outpatients and that of anticancer agents for outpatients at the chemotherapy day care center are other important activities comprising our daily clinical duties. Particularly, the former for outpatients strongly supports cancer treatment or care at home. Currently because of an increasing number of outpatients, preparations of anticancer agents are increasing every year.
We send drug information, including very important side effects, drug adoption, and drug deletion via E-mail to the medical staff.
New drugs under investigation are strictly controlled according to good clinical practice (GCP) manuals with computer registration of prescriptions. In addition, our management of investigational drugs is increasing because we must undertake a significant amount of monitoring to guarantee investigational drug accountability based on Standard Operating Procedure (SOP) of drug management.
New Developments
We are planning to explain medications to the patients more. Thus, we are planning to increase the number of patients. We want to contribute to the patient's QOL using easy-to-understand instructions concerning the drugs which are prepared by our pharmacy Division.
We are promoting the development of a drug information service for our medical staff, and are especially interested in using an intra-net system for a drug searching system and a drug discrimination searching system.
In investigational drug management, we are designing an exclusive computer-network-system to carry out still more precise management based on new-GCP guidelines.
Statistics
| Internal and external medicines | 1997 | 1998 |
| Prepared in hospital pharmacy | ||
| Total | 95,399 | 95,406 |
| Inpatients | 55,653 | 55,477 |
| Outpatients | 39,746 | 39,929 |
| Taken to outside pharmacies (% of prescription filled outside) | 29 (0.07%) | 24 (0.06%) |
| Injections | ||
| Total | 134,251 | 121,319 |
| Inpatients | 124,862 | 113,446 |
| Outpatients | 9,389 | 7,873 |
| 1997 | 1998 | |
| IVH preparations | 9,392 | 8,301 |
| Anticancer drugs | 5,135 | 5,843 |
| Others | 1,343 | 1,923 |
| 1997 | 1998 | |
| Sterilized | 29 | 32 |
| Nonsterilized | 162 | 162 |
| 1997 | 1998 | |
| Newly registered | 8 | 11 |
| Ongoing study | 26 | 18 |
| Prescriptions | 1,528 | 1,478 |
| 1997 | (%) | 1998 | (%) | |
| Total consumption | 1,810,517 | 100.00 | 1,963,990 | 100.00 |
| Internal/external medicines | 371,717 | 20.53 | 451,347 | 22.98 |
| Injections | 793,986 | 43.85 | 842,967 | 42.92 |
| Blood | 90,437 | 5.06 | 124,277 | 6.33 |
| X-ray | 133,344 | 10.96 | 210,566 | 10.72 |
| RI | 204,266 | 2.02 | 67,543 | 3.44 |
| Others | 183,200 | 12.42 | 267,290 | 13.61 |
(T. Domon)
