Title 8. DRUG UTILISATION EVALUATION (DUE) AND REVIEW (DUR).pdf ✅

PHARMD GURU Page 1 According to WHO, Drug Utilization evaluation is defined as the marketing, distribution, prescription and use of drugs in society, with special emphasis on the resulting medical, social and economic consequences. Drug Utilization Evaluation (DUE) is an ongoing authorized and systematic quality improvement process, designed to: • To optimize drug use by developing criteria and standards. • To educate clinicians and other Health Care Professionals (HCP), to increase appropriate drug use. • To provide feedback of results obtained during study to clinicians and other HCP. • To review drug use. • To analyze prescription pattern. TYPES OF DUE: 1. Quantitative DUE studies. 2. Qualitative DUE studies. DUE COMMITTEE: • DUE Committee should be composed of physicians, pharmacists and other relevant health-care professionals. • The committee must include professionals with on interest in improving drug therapy in the hospital and have ready access to experts in the medicine, surgery and major hospital specialists. • Pharmacists generally play a major role in the delivery of DUE and it is usual for the committee to include pharmacy department representation. ROLE OF PHARMACIST IN DUE: • Planning, organizing and implementing a DUE program. • Program, development, supervision and coordination. • Education of hospital staff about DUE in conceptual an practical terms. • Promotion of the goals and objectives of DUE. • Development or review of audit criteria, guidelines, study protocols and educational materials. • Development of data collection, analysis and report writing. DRUG UTILISATION EVALUATION (DUE) AND REVIEW (DUR)

PHARMD GURU Page 3 • Overuse of a more expensive medicine when a cheaper equivalent is available, as revealed in aggregate data. • Incorrect use (indication, dosage, administration) of a particular drug, as revealed in patient charts, medication error reports, ADR reports. • Inappropriate choices of antibiotic, as revealed in antibiotic sensitivity reports. • Poor dispensing process, as revealed by patient complaints or feedback. Due to the large number of medicines available at a hospital or clinic, the DTC must concentrate on those medicines with the highest potential for problems in order to get the most return on the work involved. These high-priority areas include: • High-volume drugs. • Expensive drugs. • Drugs with a narrow therapeutic index. • Drugs with a high incidence of ADRs. • Critically important therapeutic categories, for example cardiovascular, emergency, toxicology, intravenous drugs, chemotherapy and narcotic analgesics. • Antimicrobial drugs, prophylactic and therapeutic. • Drugs undergoing evaluation for addition to the formulary. • Drugs used for non-labelled indications. • Drugs used in high-risk patients. • Common clinical conditions often poorly treated. STEP 3 Establish criteria for review of the medicine: DUE criteria are statements that define correct drug usage with regard to various components. Criteria for the use of any medicine should be established using the hospital’s STGs (assuming that they have been correctly developed). In the absence of hospital STGs, criteria may be based on recommendations from national or other locally available satisfactory drug use protocols, other relevant literature sources, and/or recognized international and local experts. Credibility, and staff acceptance, of the DUE relies on using criteria that have been developed from reading established evidence-based medicine information from reputable sources and that have been discussed with prescribers. COMPONENTS OF DRUG USE FOR DUE CRITERIA: • Uses: appropriate indication for drug, absence of contraindications. • Selection: appropriate drug for clinical condition.
PHARMD GURU Page 4 • Dosing: indication-specific dosing, intervals and duration of treatment. • Interactions: absence of interactions - drug-drug, drug-food, drug-laboratory. • Preparation: steps involved with preparing a drug for administration. • Administration: steps involved in administration, quantity dispensed. • Patient education: drug and disease-specific instructions given to patients. • Monitoring: clinical and laboratory. • Outcome, for example: decreased blood pressure, blood glucose, asthma attacks. Reviewing many criteria will make the DUE process more difficult, and may impair successful completion of the review. Therefore the number of criteria established for each medicine is often between 3 and 5. Once the criteria are established, thresholds or benchmarks are decided for each criterion in order to define the expectations or goals for compliance with the criteria. Ideally one would like 100% of all cases to comply with the criteria, but in reality this may not be possible, and a DTC might decide to set a threshold of 90-95% compliance below which they would instigate corrective action. STEP 4 Data collection: Data may be collected retrospectively, from patient charts and other records, or prospectively, at the time a medicine is prepared or dispensed. Retrospective data collection may be quicker and is best accomplished away from the patient care areas and distractions. The advantage of a prospective review is that the reviewer can intervene at the time the medicine is dispensed to prevent errors in dosage, indications, interactions or other mistakes. A particular example of this is the computerized systems used in some pharmacies; here the computer warns the pharmacist if patient data being entered into the computer fails to meet established criteria and requires them to correct the problem(s) noted. Such a system can also provide a large database for use retrospectively. Data must be collected from a suitable random sample of charts or prescription records from the health-care facility, usually selected by pharmacy personnel, but also by nurses or medical records personnel. The treatment of at least 30 patients, or 100 patients for common clinical conditions, should be reviewed per health facility or hospital. The larger the facility and the more practitioners, the larger the number of records needed for review and