DRUG UTILZATION EVALUATION & DRUG UTILIZATIONREVIEW

Chap. 3 Clinical Pharm II

Abuzar Khan PhD
Contents
❖DUE Introduction

❖Goals Of DUE

❖Scope Of DUE

❖DUE Process

❖Steps in DUE

❖Practical Cases
Drug Utilization Review / DUE
• MUE
• DUR
• DUE
• Drug Usage Review
• They are all having same meaning
Drug Utilization Evaluation
• DUE program
• Planned, criteria-based
• Systematic process
• Monitoring, evaluating, and continually
• Improving medication use
• Aim
• Improving medication-related outcomes
• Group of Patients or consumers
DUE Introduction
Mainly Focuses on

• Patient assessment
• Prescribing
• Preparation and dispensing,
• Administration

• Patient monitoring for medication safety and efficacy,

• Patient education.
DUE Introduction
• Drug Audit?
• Single evaluation focusing on a particular medication, drug class, disease state,
or process.
• Data Collection, Organized, Analyzed, Report.
• Small component of DUE
• Drug regimen review
• Review of an individual patient’s medication regimen
• Reviewing the appropriateness of a new prescription
• Pharmacist’s personal judgement. rather than explicit criteria
• Pharmaceutical Care
DUE Definition
• Formal program for assessing data on drug use
• against
• Explicit, prospective standards
• and
• as necessary, introducing curative strategies to achieve
• Outcomes
• Indicators are Red flag
• Quantitative measure
• Postoperative infection rate
Importance of DUE
• Medication improvement initiatives
• Formulary system
• Adverse drug reaction reporting
• Medication error prevention
• Pharmacist interventions
• Clinical pharmacy services.
Goals of DUE

Effectiveness Medication Treatment Cost

Efficiency safety Optimizing
Patient care
Satisfaction
Role of Pharmacist
• Responsibility
• Interdisciplinary
• Involving physicians
• and other prescribers, nurses, pharmacists, administrators,
• Patients or consumers
• Pharmacist should act a leader
Scope of DUE
• High Risk
1 • Anticoagulants, chemotherapy, immunocomproised

• High Use/High Volume

2. • Most common medicines, procedures, diseases, e-g antibiotic use

• High Cost
3. • Costly medicines, procedures

• Associated with high risk patient groups

4.

• Problem prone
5.
DUE Process
•Retrospective
1
•Prospective
2
•Concurrent
3
DRUG UTILZATION EVALUATION & DRUG UTILIZATIONREVIEW

Part II Practice
Practice case Surgery DUE
• Rate of postoperative infections for abdominal surgeries was
significantly higher than the national average
• The pharmacy director informed the committee of his observation that
cefoxitin was often used for these patients, a costly and inappropriate
choice.
• The committee decided to undertake a DUR for antibiotic prophylaxis
in abdominal surgery wound infection.

• The health problem met all indications for a DUR: high use, high cost,
high risk, and problem prone
Priority of Problem
Steps In DUE
1 • Establish Responsibility

2 • Develop Scope

3 • Establish Criteria

4 • Data collection and Results

5 • Analysis

6 • Recommendations and action plan

7 • Follow-ups
Steps In DUE
• Step I. Establish Responsibility
• Hospital committee, Plan of activity, establish procedure to govern
committee. Distribute activities and responsibilities.

• Step II Develop Scope.

• Identify medicine use problem
• Priorities should be
• High-volume medicine use
• Medicines with a low therapeutic index
• Medicines with a high incidence of ADRs
• Expensive medicines
Steps In DUE
• Step III Establish Criteria
• Literature based
• Local and international experts
• STG must be acceptable to medical staff
• Developing threshold
• Pharmacy administration indicators
✓Correct cost to patient
✓Accurate billing records
✓Accurate dispensing records
✓Appropriate use of generic medicines or therapeutic equivalents
✓Appropriate use of formulary medicines
✓Appropriate quantity dispensed
Steps In DUE
• Step IV Data collection and Results
• Prospective retrospective concurrent
• Questionnaire, PDAs, Chart review, computerized software system
• Graphical or Descriptive results

• Step V Analysis
• Data analysis quarterly annually
• Tabulate data
• Statistics analysis
• If a threshold is not met, it may indicate a medicine use problem that
requires the attention of the DTC
Steps In DUE
• Step VI Recommendations and action plan
• Specific steps to correct any medicine use problem
• After results DTC must decide to
• Continue, discontinue, or expand the functions of the DUE

• Step VII Follow-ups

• Follow-up in every DUE is critical to ensure resolution of any
unresolved medicine use problems
Problems with DUE
1. Lack of authority

2. Poor Prioritization

3. Poor follow Up

4. Poor Documentation
Practice case Surgery DUE
• Surgeons are selecting antibiotics that are
• Not medicine of choice for the indicated procedure.
• High doses of antibiotics.
• Preoperative doses are delayed
• Prescribe antibiotics for patients who do not meet criteria for dirty
surgery.
•.
Practice case Surgery DUE
Practice case AUR In Kenya
•Thanks