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

PHARMD GURU Page 3  Ideally the DTC should establish annual plans, outlining which medicines or clinical conditions will be a part of the DUE process. STEP 2: DEVELOP THE SCOPE OF ACTIVITIES AND DEFINE THE OBJECTIVES: The DTC should decide upon the objectives of the DUE and the scope of the activities necessary. The scope can be very extensive or it can focus on a single aspect of drug therapy and will depend upon the type of problem identified, for example:  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
PHARMD GURU Page 4 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.  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