ハイパーポリファーマシーに対する病棟薬剤師による介入効果. (Japanese)

There has been great interest in eliminating polypharmacy recently. We report a case in which a pharmacist intervened in deprescribing for a patient with hyperpolypharmacy. A 51-year-old woman was admitted to the orthopedic ward of our hospital for total hip replacement. The patient was taking 34 oral medications at the time of admission. The Functional Independence Measure (FIM) was used to assess activities of daily living (ADL). The patient underwent surgery on the third day of hospitalization, and on the eighth day, the pharmacist confirmed that the patient was over-sedated, which could have been due to duplicate drug administration. The pharmacist asked the attending physician to consult the psychiatrist. As a result, six drugs were discontinued on the ninth day of hospitalization. On the same day, the pharmacist proposed discontinuing drugs for which the reason for prescription was unknown; three more drugs were discontinued, and the patient's level of consciousness improved. The number of medications at the time of hospitalization was reduced by 14. After admission, laboratory data showed improvement in aminotransferases (AST, ALT) and creatine kinase. FIM scores increased 2.7-fold for motor items and 1.2-fold for cognitive items. The most common medications reduced were neuropsychiatric drugs. The deprescribing of hyperpolypharmacy possibly improved motor function recovery. The pharmacist's proactive approach reduced side effects and improved ADL. [ABSTRACT FROM AUTHOR]

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