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国立がん研究センター 中央病院

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Department of Pharmacy

Hiroyuki Terakado

Introduction

The Department of Pharmacy stores and dispenses drugs, prepares injections (including aseptic mixtures), collects and disseminates drug information and provides patients with guidance regarding the proper use of drugs. Its services have improved toward the hospital's goal of envisaging the highest quality of medical care, practice and research. A state-of-the-art computerized system and other pharmacy-related equipment ensure quality control and inventory management, promote the proper use of drugs, and enhance the efficiency and quality of our services.

Routine activities

As part of the fundamental function of the hospital, the Department prepares and dispenses oral and topical medicines and injections for individual patients. All outpatients and inpatients are provided with aseptic mixtures of injectable chemotherapy agents prepared in the Department. As the importance of providing drug information for patients has been widely acknowledged, clinical pharmacists visit inpatients and give advice on taking medicine, focusing especially on pain control with opioids, and participate in the palliative-care support team, while the Pharmacy provides outpatients with guidance in the proper use of opioids and anti-cancer agents. The Department also places pharmacists in every hospital ward to provide a medication reconciliation service for inpatients, with a view to enhancing the quality of chemotherapy as well as to ease the burden of doctors and nurses.

Pharmacists collect, compile, and maintain a database of drug information and distribute pertinent information to the medical staff. Drug information is disseminated quickly throughout the hospital by paper distribution and/or on the in-hospital computer network. Pharmacists individualize dosage regimens for specified drugs such as tacrolimus, aminoglycosides, and vancomycin based on both measured blood concentrations and pharmacokinetic analysis to maximize their efficacy and minimize adverse events.

A physician places an order through the hospital's computerized electric medical record system. The prescription order is then redirected to the medicine-package-printing system that provides drug information. The medicine-package information, instructions and explanations, which are easy to understand for patients, for the proper use of drugs, such as those regarding efficacy and effectiveness, precautions, and guidance concerning symptoms at the early stage of adverse reactions, are automatically printed out for patients when a prescription is ordered.

The injection-order is directly linked to an automatic “picking system” device, and this linkage ensures that injections are made properly and efficiently. This injection-ordering system contains an additional function, a regimen-ordering system for anti-cancer drugs that makes it possible to check the dose as well as the interval of chemotherapy. The Department has a robot that prepares injection preparations without human assistance.

Research activities

Since an important mission of the Department is to contribute to the development of new drugs, inventory control and handling of new investigative drugs are performed in accordance with Good Clinical Practice regulations. Research on the safety management of chemotherapy is conducted including handling of chemotherapeutic drugs, reduction of incidents regarding drugs, and improvement of pain control for patients who need palliative care through the use of guidance materials. A couple of studies on the pharmacokinetics and pharmacodynamics of cancer-related drugs have been performed and some of the results have been reported in international conferences and journals.

Information Services

The mission of the Pharmacy Information Services is to provide an evidence-based foundation for safe and effective drug therapy for cancer patients. The internal online pharmacy journal is published monthly. Current safety information, newly adopted drugs, questions-and-answers, and topic of approvals are available for medical staff on the in-hospital computer network. The Department also provides a variety of information on the Internet to the general public and medical experts outside the hospital.

Education and Training

The National Cancer Center Hospital offers three-year postgraduate pharmacist residency training in clinical oncology. In the first year, the program attaches the most importance to the technical aspects of cancer care. In the second year, through required rotations in a variety of focused hematology/oncology services, the resident will refine his/her clinical problem-solving skills in cancer management and patient education, as well as provide pharmaceutical care to ambulatory care patients and participate in an oncology-focused Drug Information Program. In the third year, residents participate in specialized pharmacoclinical practice and research activities, which may be tailored to the resident's goals. The hospital also provides a two-year chief residency program in which post-residency trainees may develop their clinical research capabilities to a higher level. Moreover, there are opportunities for educational activities, such as a training course for visiting expert pharmacists and post-graduate students of pharmacy, and participation in a multi-institutional TV conference.


Table 1. Number of Prescriptions in 2015 Table 2. Amounts of Drugs Consumed in 2015


Table 3. Aseptic Preparation of Injectable Drugs in 2015 Table 4. House Preparations in 2015


Table 5. Investigational Drugs

List of papers published in 2015

Journal

  1. Motonaga M, Yamamoto N, Makino Y, Ando-Makihara R, Ohe Y, Takano M, Hayashi Y. Phase I dose-finding and pharmacokinetic study of docetaxel and gefitinib in patients with advanced or metastatic non-small-cell lung cancer: evaluation of drugdrug interaction. Cancer Chemother Pharmacol, 76:713-721,2015