Worksheet

Drug Utilization Review

No.4 Title of the Activity Score

Course&
Student’s Name
Year/ Sec
Date
SME’s Name
Performed
Class Schedule Group No.

I. Objectives:
1. To determine the main purpose and importance of a patient drug profile that a
clinical pharmacist develop.

2. To determine what really is a Drug Utilization Review.

II. Materials:

Patient drug profile form

III. Site/Location of the Hospital:

Name of the Establishment: _______________________________________________

Address: _________________________________________________________________

IV. Procedure:

1. Secure the name of your patient.

2. Extract the medication history by means of interview or if not possible by
means of an interview questionnaire where the following are elicited:
a) Medication taken during the past (medication history)
b) Medication taken at the time of admission.
c) Home remedies used

Your ID number here 1

 d) Drug Allergies
e) Idiosyncrasy towards food products.
3. Develop a patient drug profile.

V. Data and Observation:

(Pls attached the patient drug profile form)

NAME :
AGE :
ADDRESS :
DATE OF ADMISSION :
LENGTH OF STAY :
PHYSICIAN :
DISPOSITION :
INITIAL DIAGNOSIS :
FINAL DIAGNOSIS :
:
:
OTHER DISEASE INFLUENCING LENGTH OF STAY :
:

RECOMMENDATION :

2
MEDICATION TAKEN AT THE TIME OF ADMISSION:

SURGICAL PROCEDURE:

HOME MEDICATIONS:

Medications Dosage Time Remarks

INTRAVENOUS SHEET

3
MEDICATION SHEET

4
PRN MEDS

STAT MEDS

5
VI. Questions:

1. What is Drug Utilization Review?

Drug utilization review (DUR) is defined as an authorized, structured, ongoing

review of prescribing, dispensing and use of medication. DUR encompasses a drug

review against predetermined criteria that results in changes to drug therapy when

these criteria are not met. It involves a comprehensive review of patients'

prescription and medication data before, during and after dispensing to ensure

appropriate medication decision-making and positive patient outcomes.

2. Within the hospital, what body or department is in charge of drug utilization

review?

Drug Utilization Review (DUR) is a coordinated effort by physicians and

pharmacists to ensure the desired outcome for a patient. Drug Utilization Review

can be done prospectively by the pharmacist while a prescription is being

processed or retrospectively by the medical service association by reviewing

claims data and other records for utilization patterns.

3. For what purpose is a patient drug profile developed by a clinical pharmacist?

The purpose of a patient drug profile developed by a clinical pharmacist is to give

records information about a patient’s drug therapy. Patient drug profile can help or

contribute to a better patient care by enhancing the pharmacist’s ability to

efficiently perform his professional duties. However, a properly maintained PMP

also can be of significant medical value to the patient, if it is used effectively to

evaluate the patient's medications.

6
VII. CONCLUSION:
In conclusion, Drug Utilization Review (DUR) is really important because it serves as a
coordinated effort between a pharmacist and a physician. This DUR helps to ensure
the desired outcome for a patient safety. On the other hand, the patient medication
drug profile is also necessary because it consists of records of information all about
the patient history. This can help in building a better care for a patient by the help of a
medical professionals. This drug information about the patient may provide an
authentic, accurate, and a relevant drug information communication system to the
end user or even for a healthcare professional about the related medication to be
given. Lastly, taking the drug medication profile of our patient is really important
most especially in controlling and securing the different chronic conditions,
temporary conditions and even the long-term health condition and well-being of our
patient.

7
 Patient Profile
Patient background and medication list
Patient’s details

Initials: IF Age: 40 Gender: Male

Weight: 139.7kg Height: 510 metres BMI: >47

Patient history

Medication list

Treatment Indication and evidence

COPD rescue pack PRN COPD
Lisinopril tablets 5mg OM Hypertension
Omeprazole EC capsules 20mg Proton pump inhibitor (PPI) given steroid use
OM
Prednisolone tablets (reducing COPD exacerbation (started 1 week ago, therefore to start at 30mg daily on
course): admission to hospital)
40mg OM for 7 days, then 30mg
OM for 2 weeks then reduce by
5mg every 2 weeks then stop
Quetiapine tablets 25mg BD Treatment of depression in borderline personality disorder1
Salbutamol 100 microgram MDI COPD
2 puffs PRN
Salbutamol 2.5mg/2.5ml COPD
nebuliser solution 2.5mg PRN
Tiotropium 2.5 microgram MDI 2 COPD maintenance therapy as per BNF and NICE guidelines2
puffs
OM
Venlafaxine MR capsules 75mg Major depression3. According to NICE guidelines CG90, this patient fits into
OM step 3 of the stepped-care model since is on combined treatment with
ineffective response to initial interventions and requires follow-up for
further assessment4
Drug sensitivities: NKDA

8
Medication changes

Treatment Route Dose & Indication Start date Stop date

frequency
On
Lisinopril tablets PO 5mg OM Hypertension admission 9/12/15
Hypertension – dose increased
following intervention (see drug-related
Lisinopril tablets PO 10mg OM problem/progress notes) 10/12/15 -
Proton pump inhibitor (PPI) given On
Omeprazole EC capsules PO 20mg OM steroid use admission -
30mg OM for 2
weeks then
reducing as On On
Prednisolone tablets PO above COPD exacerbation admission admission
30mg OM for 2
days then COPD exacerbation – this was
reduce by 5mg prescribed
every 3 days incorrectly (see drug-related
Prednisolone tablets PO then to stop problem/progress notes) 8/12/15 9/12/15
30mg OM for 2
weeks then COPD exacerbation – doses were
reducing as altered to established treatment dose
Prednisolone tablets PO above after my intervention 10/12/15 -
Depression in borderline personality On On
Quetiapine tablets PO 25mg BD disorder admission admission
On
Salbutamol MDI IH 2 puffs PRN COPD admission -
COPD – not prescribed on admission
due to tachycardia and chest ‘not too
bad’ as per patient. Continued on On On
Salbutamol nebuliser IH 2.5mg PRN discharge. admission admission

9
Medication changes

Treatment Route Dose & Indication Start date Stop

frequency date
On
Tiotropium MDI IH 2 puffs OM COPD maintenance therapy admission -
Venlafaxine MR On
capsules PO 75mg OM Major depression admission 10/12/15
37.5mg OM Major depression – dose reduced as
for per psychiatry review (see progress
Venlafaxine tablets PO 2weeks notes) 10/12/15 -
50mg PRN
(max
Cyclizine tablets PO/IV 150mg daily) Nausea 9/12/15 11/12/15
100mg OM for
Doxycycline capsules PO 4 days LRTI 9/12/15 12/12/15
Paracetamol tablets PO 1g PO PRN Pain relief if required 9/12/15 11/12/15
As recommended by psychiatrist for
anxiety. Benzodiazepines are
5mg BD for 2 indicated for short-term relief for
Diazepam tablets PO weeks up to 4 weeks as per BNF5 10/12/15 24/12/15
Monitoring plan and outcomes

Parameter Justification Frequency Result/s or plan

Blood pressure Important to monitor as patient presented On admission then 8/12/15 – 182/103, 199/119
(normal 120/80) with hypertension on admission. Patient is on 2 9/12/15 – 175/123, 158/75
venlafaxine which should be used with hourly till BP 10/12/15 – 162/86
caution in hypertension and contraindicated within normal
in uncontrolled hypertension. range
Temperature Infection marker Daily if in range 8/12/15 – 35.9
(normal 37.5) and more often if 9/12/15 – 35.6
raised
White cell count Infection marker 8/12/15 – 21.2
(normal 3.7-11 x 9/12/15 – 13.3
10^9/L)
Neutrophils Infection marker 8/12/15 – 16
(1.7-7.5 x 10^9/L) 9/12/15 – 7.8
eGFR Determines renal function – important to 8/12/15 - >60
(eGFR>60ml/min) monitor to determine if the doses of 9/12/15 - >60
medications are appropriate
Sodium 8/12/15 – 139
(133-146mmol/L) 9/12/15 – 140
Potassium 8/12/15 – 4.0
(normal 3.5- 9/12/15 – 3.9
5.3mmol/L)
Heart rate 8/12/15 – 122 (regular)
(60-100bpm) 9/12/15 – 113 (regular)
10/12/15 – 78
Respiratory rate 8/12/15 – 19
(12-16 9/12/15 - 18
breaths/min)
GCS 8/12/15 – 15/15
(0-15 scale) 9/12/15 – 15/15
Analysis of Drug Related Problems
Drug related problem
VTE risk assessment needs
to be completed and
prophylaxis
prescribed if appropriate
Symptoms patient
experiencing may be due
to Trazadone
withdrawal
Venlafaxine is cautioned in
hypertension and should
be avoided in uncontrolled
hypertension
High blood pressure
therefore may be
appropriate to increase
antihypertensives
Your ID number here
Assessment
Important that all patients
have a risk assessment
completed on admission to
determine if prophylaxis is
required based on mobility,
thrombosis risk and bleeding
risk.
BNF states that influenza-like Medium
symptoms can occur with
tricyclic and related
antidepressant withdrawal,
therefore should be withdrawn
slowly3.
Patient’s blood pressure was
high (182/103) on admission
On admission patient was on
Lisinopril 5mg daily for
hypertension. According to
observations in hospital, it
appears that his blood
pressure has not been well
controlled therefore may
need dose increasing
Priority Action taken/outcome
(high /
medium
/low)
High Patient admitted to hospital not
long ago so documented in patients
notes to ensure risk assessment
gets completed. Weight
documented is 139.7kg so based on
this twice daily dosing of enoxaparin
would be appropriate (as for all
patients >100kg).
Risk assessment completed and no
thromboprophylaxis was required as
patient was not expected to have
ongoing reduced mobility relative to
normal state.
Documented in notes that symptoms
patient presented with may be
indicative of Trazadone withdrawal
symptoms.
Await psychiatry review.
High Documented in the patients notes
so that the multidisciplinary team
were aware that blood pressure
should be monitored closely due to
hypertension and patient being on
venlafaxine.
Note was acknowledged by doctor
review later that day.
Await psychiatry review.
Documented in notes the
importance of monitoring blood
pressure (as above) and the need to
get medicines reviewed by
psychiatric team. I also queried the
need to increase Lisinopril dose or
step up therapy
to ensure blood pressure is reduced
and 7
stays
 accordingly.
Progress notes and drug related problems
Drug related problem
Patient is a smoker
Patient has been on
back-toback course of
steroids since
mid November
Frequent COPD
exacerbations therefore
need to review inhaler
technique
Assessment
Important that smoking
cessation is offered to this
patient for his overall
health but especially as this is
an important management
approach for
COPD patients as stated in the
NICE guidelines2
Upon taking the drug history,
found out patient on
prednisolone 30mg daily for 2
more days, to be reduced by
5mg every 3 days then to stop.
However patient has been on
backto-back steroid courses
since midNovember.
within normal range.
Priority Action taken/outcome
(high /
medium
/low)
Medium Notes stated that patient had been
offered smoking cessation advice but
patient had not expressed any
willingness to give this a go.
Medium Note left for doctor’s to review. GP
surgery contacted as to why
prescribed – patient felt not getting
on top of symptoms so steroid
started.
For COPD review.
Medium Patient seems to use inhalers as
directed and reported no compliance
issues, however needs respiratory
review to possible increase inhaler
doses to reduce frequency of
exacerbations of COPD
Progress notes

Date Notes

9/12/15 Quetiapine stopped pending psychiatry review. Patient experiencing tachycardia, nausea, vomiting,
sweating since commencing on Sunday.
10/12/15 Psychiatry review: they advised the following:
-Stop quetiapine and start venlafaxine 37.5mg daily for 2 weeks – patient will be reviewed in clinic
with consultant psychiatrist -Diazepam 5mg BD for 2 weeks
-Review in clinic in 2-3 weeks – aware of caution with hypertension
-Presume any causes have been ruled out for acute onset of nausea and vomiting
-Overnight observation due to mother’s concern and patient increasingly anxious, not eating well and
mother wanted to speak to consultant.

Discharge / ongoing planning and follow up

Discharge / ongoing plan and follow up

Discharge requirement Action taken / forward communication

Discharge prescription forwarded to GP and copy for
patient
Outpatient cardiology review
Follow-up with psychiatrist in 2 weeks from discharge.
Continuing Professional Development

Learning plan and record

Learning need identified Action taken

I want to learn/revise about other This is an outstanding learning need which I have identified from
cautions/contraindications for drugs doing this patient profile. I will use the BNF and refer to NICE
used in depression guidelines to carry out this learning
 Worksheet TRANSMITTING A
PHYSICIAN’S MEDICATION
No.10 ORDER TO THE PHARMACY
Title of the Activity Score

Abugan, Andreea Maureen

Artieda, Jeroe
Baquiran, Jenny Lou
Bisnar, Mae Fellice
Course&
Student’s Name Facinal, Shawn Lloyd BSPharmacy- 3
Year/ Sec
Facturanan, Mahal Leah
Palec, John Roy
Roma, Justin Miguel
Ungui, Ivan Jules

September
Date
SME’s Name Jeasa Marie Valenzona 28,2020
Performed
Carlos, RPh
Class Schedule MWF 2:15-4:15 Group No. #1

I. Objectives 1. To determine what is drug distribution system.

2. To determine the different methods used in drug distribution.

II. Materials Hospital Pharmacy Manual

Ball pen

III. Site/Location of the Hospital:

Name of the Establishment: Socsargen Country Hospital

Address: L. Arradaza St., Corner Bula-Lagao Road, General Santos City

IV. Procedure

1. Secure a sample of medication written by a licensed physician.

2. Trace how the physician’s medication is processed in the pharmacy.
3. Note down the advantages and disadvantages in the type or method use in
your assigned hospital.
4. Organized and make a flow chart of the type of transmitting a physician’s
medication order to the pharmacy. Make your own recommendation.
V. Observation:

______________________________________________________________________
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SAMPLE OF THE PRESCRIPTION
 FLOWCHART OF MEDICATION ORDER

THE DISPENSING CHARGED MEDICINES TO IN-PATIENTS

DISPENSING CHARGED MEDICATIONS TO OUT-PATIENTS
DISPENSING CASH MEDICINES
DISPENSING OF DANGEROUS DRUGS
VI.QUESTIONS:

1. What is a Drug distribution system?

Safe, accurate, well-designed and efficient drug distribution systems are

critical to safe patient care. Drug distribution is one of the basic services provided
by the hospital pharmacy. Endorses the unit-dose/intravenous admixture system
as the drug distribution system of choice in organized healthcare settings.

2. What constitute a Hospital Drug Distribution System?

Outpatient- refers to patients not occupying beds in a hospital, clinics, health

centers. The patients with minor and common illness go to O.P.D for consultation
to the physician.

In-patient Services - the drug distribution of the inpatient department can be

carried out from the outpatient dispensing area. If the workload is heavy then
additional personnel can be employed.

3. What are the methods in transmitting physician’s medication order to the

pharmacy?

IP drug distribution

1. Individual prescription order system - used in small or private

hospitals because of its economic considerations and reduced manpower
requirements.
2. Complete floor stock system - drugs are stored at the nursing
station and are administered by a nurse according to the chart order of the
physician.
3. Unit dose dispensing method - medications which are ordered,
packaged, handled, administered, and charged in multiples of single doses
units containing predetermined number of drugs or sufficient for one regular
dose, application or use.
4. Combination of individual prescription system and complete
floor stock system- a type of drug distribution system that uses individual
prescription or medication order system as their primary means of
dispensing but also utilizes a limited floor stock.
VII. Conclusion:

In this activity, we have learned that drug distribution is essential in

achieving safe and accurate patient care. This system is used to provide standards
for the purchase of drugs, chemicals and proper storing of drugs. All medication
orders in this system are directly viewed by the pharmacist. It also provides the
interaction of pharmacist, physician, nurse and the patient. The different methods
for drug distribution system are the unit dose dispensing method, complete floor
stock system, individual prescription order system and the combination of
complete floor stock system and individual prescription order which is also
important in giving orders or dispensing medicines to the patient to make it more
accessible, convenient and also to achieve proper patient care.
 PREPARATION OF IV ADDITIVE
Worksheet SOLUTIONS AND IV ADMIXTURE

No.11 Title of the Activity Score

Abugan, Andreea Maureen

Artieda, Jeroe
Baquiran, Jenny Lou Course&
Student’s Name Bisnar, Mae Fellice BSPharmacy- 3
Facinal, Shawn Lloyd Year/ Sec
Facturanan, Mahal Leah
Palec, John Roy
Roma, Justin Miguel
Ungui, Ivan Jules

Date
SME’s Name Jeasa Marie Valenzona September
Performed
Carlos, RPh 28,2020

MWF 2:15-4:15
Class Schedule Group No.
1

I. Objectives 1.Tto identify the different typical IV admixtures prepared

by the Hospital Pharmacy.

2. To determine the advantages of IV admixture

preparation in a centralized pharmacy.

II. Materials Hospital Pharmacy Manual

Ball pen

III. Site/Location of the Hospital:

 Name of the Establishment: Socsargen Country Hospital
Address: L. Arradaza St., Corner Bula-Lagao Road, General Santos City

IV. Procedure

1. Observe the utilization of a pharmacy controlled IV Admixture services.

2. Observe and note down the different typical IV admixture prepared by
the Hospital pharmacy.
3. Prepare one IV admixture of your own choice and label properly. Submit
this to your preceptor.

4. Note down of proper guidelines in the prescription of IV additive solutions

and admixtures are advocated by the hospital. If not, list down
suggestions or guidelines for the preparation of IV additive solutions and
admixtures.

V.Observation/Results:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________

VI.Questions
1. What is an IV additive solution? Give the synonyms.
IV solution additives are concentrated preparations containing substances used
for correcting fluid and electrolyte balance and nutritional status.
2. What are IV admixtures? Give examples.

It is a combination of one or more sterile products added to an IV fluid for

administration or Pharmaceutical mixture of two or more drugs into a large bag
or bottle of IV fluid. It must be sterile and nonpyrogen, Aseptic techniques are
used to mixed the products.
Examples: • Infusion - Basic fluid and electrolyte therapy, More effective and less
toxic than when given intermittently.
• Intermittent – for Periodic administration, Increased efficacy and Reduced
toxicity.
• Pre-mixed IV admixtures – examples are Lidocaine, Potassium, Nitroglycerine
3. Who are the personnel qualified to prepare IV admixtures?

Personnel that are qualified to prepare IV admixtures are:

A trained hospital Pharmacist, pharmacy technician or personnel that have a
proper training in aseptic technique and sterile product information.

4. Give at least ten (10) advantages in a centralized pharmacy for IV admixture

preparation.
1. More economical

2. Reduce personnel time

3. Safety with standardization of solutions
4. There will be quality control and assurance
5. Risks and errors are reduced
6. Easily to compound commercially unavailable products

7. Increases the safety of parenteral medication

8. Ensures sterility

9. Ensures appropriate labeling

10. Easily validate documentation

5. What are typical IV orders with admixtures?

Typical IV orders with admixtures are:

• Mannitol Solution
• Potassium Chloride

• Lidocaine Hydrochloride
• Total Parenteral Nutrition Solutions
• Multiple Vitamin Infusion (MVI®)
• Heparin Sodium
 • Calcium Chloride
• Amiodarone Hydrochloride

• Diphenhydramine Hydrochloride
• Digoxin

• Magnesium Sulfate
• Sodium Bicarbonate
• Epinephrine Hydrochloride

• Nitroglycerin
• Aminophylline
• Dopamine

VII. Conclusion:

Therefore, IV solutions prepared for a fastest way of delivering medications and

as fluid replacement throughout the body. Hospital pharmacists have long been
responsible for the management of compounded IV preparation. Pharmacists
also controls the adequate supply of medication and serve as a stewards of the
medication cost to both patient and healthcare organization. In a centralized
pharmacy for IV preparation it improvesthe management of drugs and ensured
the quality of iv fluids.

VIII.Instructor’s Note:
 TOTAL PARENTAL NUTRITION
Worksheet
No.12 Title of the Activity Score

Abugan, Andreea Maureen

Artieda, Jeroe
Baquiran, Jenny Lou Course&
Student’s Name Bisnar, Mae Fellice BSPharmacy-
Facinal, Shawn Lloyd Year/ Sec 3
Facturanan, Mahal Leah
Palec, John Roy
Roma, Justin Miguel
Ungui, Ivan Jules

Date
SME’s Name Jeasa Marie Valenzona September
Performed
Carlos, RPh 28,2020

MWF 2:15-4:15
Class Schedule Group No.
1

I. Objectives 1. To determine the importance of Total Parenteral

Nutrition in the hospital setting and its composition.

2. To know patient monitoring in administering Total

Parenteral Nutrition.

II. Materials Hospital Pharmacy Manual

Ball pen

III. Site/Location of the Hospital:

 Name of the Establishment: Socsargen Country Hospital
Address: L. Arradaza St., Corner Bula-Lagao Road, General Santos City

IV. Procedure

1. Observe and note down the importance of Total Parental Nutrition in the
hospital setting.
2. Observe one patient who have been administered with Total parental
nutrition.

3. Note down the proper guidelines on preparing TPN and the qualification
of personnel preparing it.

V.Observation
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

VI.Questions:
1. What is the importance of TPN?
Parenteral nutrition, or intravenous feeding, is a method of getting nutrition into
your body through your veins. This form of nutrition is used to help people who
can’t or shouldn’t get their core nutrients from food. Parenteral nutrition delivers
nutrients such as sugar, carbohydrates, proteins, lipids, electrolytes, and trace
elements to the body. These nutrients are vital in maintaining high energy,
hydration, and strength levels. Some people only need to get certain types of
nutrients intravenously.
2. What are the tools for nutritional assessment?
(1) anthropometric measurements of body composition;
(2) biochemical measurements of serum protein, micronutrients, and metabolic
parameters;

(3) clinical assessment of altered nutritional requirements and social or

psychological issues that may preclude adequate intake; and

(4) measurement of dietary intake.

Techniques for measuring body composition of fat and lean body mass include
anthropometry and bioelectric impedance analysis. Other techniques, including
dual X-ray absorptiometry (DXA), hydrodensitometry, total body potassium
measurement, and cross-sectional computed tomography or magnetic
resonance imaging are available in research centers.
3. What are the compositions of TPN?

TPN is a mixture of separate components which contain lipid emulsions,

dextrose, amino acids, vitamins, electrolytes, minerals, and trace elements.
4. How do we monitor patients taking TPN?

Progress of patients with a TPN line should be followed on a flowchart. An

interdisciplinary nutrition team, if available, should monitor patients. Weight,
complete blood count, electrolytes, and blood urea nitrogen should be
monitored often (eg, daily for inpatients). Plasma glucose should be monitored
every 6 hours until patients and glucose levels become stable. Fluid intake and
output should be monitored continuously. When patients become stable, blood
tests can be done much less often.

Liver tests should be done. Plasma proteins (eg, serum albumin, possibly
transthyretin or retinol-binding protein), prothrombin time, plasma and urine
osmolality, and calcium, magnesium, and phosphate should be measured
twice/week. Changes in transthyretin and retinol-binding protein reflect overall
clinical status rather than nutritional status alone. If possible, blood tests should
not be done during glucose infusion.

5. What is the difference between Wet method and Dry Method technique in
preparing TPN?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________

VII.Conclusion:
Total parenteral nutrition (TPN) is a method of feeding that bypasses the
gastrointestinal tract. Fluids are given into a vein to provide most of
the nutrients the body needs. TPN can be administered in the hospital or at home
and is most often used for patients with Crohn's disease, cancer, short bowel
syndrome or ischemic bowel disease. However, critically ill patients who cannot
receive nutrition orally for more than four days are also candidates for TPN. TPN is
one of the best course of action in patients who are terminally ill, those in the
neighborhood of coma or in paralysis, since obviously they cannot take their own
food by mouth, their nutrients are sent via nerves, the advantages are: Parenteral
nutrition provides requisite nutrients to patients intravenously, thereby bypassing a
nonfunctional GI tract, they are already soluble so the body don’t have to work
for it as much as eating where you have to break down the food that you ate
before getting the nutrients.