Development and pharmacist‐mediated use of tools for monitoring atypical antipsychotic‐induced side effects related to blood glucose levels

• Published in: Pharmacoepidemiology and drug safety 2018-12, Vol.27 (12), p.1379-1384
• Main Authors: Ishida, Shunsuke, Takechi, Kenshi, Bando, Hiroshi, Imanishi, Masaki, Zamami, Yoshito, Chuma, Masayuki, Yanagawa, Hiroaki, Kirino, Yasushi, Nakamura, Toshimi, Teraoka, Kazuhiko, Ishizawa, Keisuke
• Format: Article
• Language: English
• Subjects: Antipsychotics; atypical antipsychotics; Blood; clinical intervention; clinical value; Coma; Diabetes; Diabetes mellitus; Diabetic ketoacidosis; Drug abuse; Electronic medical records; Glucose; Glucose metabolism; Ketoacidosis; Medical electronics; Medical personnel; Monitoring; Pharmacists; pharmacoepidemiology; Psychotropic drugs; Side effects; Sugar
• ISSN: 1053-8569; 1099-1557
• DOI: 10.1002/pds.4656

Purpose Drug side effects often lead to serious outcomes. Administration of second‐generation antipsychotics has resulted in diabetic ketoacidosis and diabetic coma leading to death. Therefore, pharmacists are required to collect information on clinical test values, determine the appropriate test timing, and coordinate with doctors for further clinical laboratory orders, all of which are labor‐intensive and time‐intensive tasks. In this study, we developed a side effect‐monitoring tool and aimed to clarify the influence and efficiency of monitoring side effects by using the tool in patients taking atypical antipsychotics in whom it is necessary to check clinical test values such as blood sugar levels. Methods We extracted clinical test values for patients treated with second‐generation antipsychotics from electronic medical records. The test values are automatically displayed in the side effect grade classification specified by CTCAE ver. 4.0. A database was constructed using scripts to provide alerts for the timing of clinical testing. The pharmacist used this tool to confirm clinical test values for patients taking medication and requested the physician to inspect orders based on the appropriate test timings. Results The management tool reduced the pharmacists' effort in collecting information on patients' prescription status and test values. It enabled patients to undergo tests at the appropriate time according to the progression of glucose metabolism and allowed for easy monitoring of side effects. Conclusions The results suggested that regardless of pharmacists' experience or skill, the introduction of this tool enables centralization of side effect monitoring and can contribute to proper drug use.