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Australian Journal of Pharmacy : February 2005
shpa an updated SHPA Standards of Practice for Drug Use Evaluation in Australian Hospitals.1 T HE Society of Hospital Pharmacists of Australia (SHPA) recently adopted The previous standards of practice were adopted in 1996. The review was undertaken by the SHPA Committee of Speciality Practice in Drug Use Evaluation. Drug use evalua- tion (DUE) is a systemic quality improve- ment activity aimed at improving the quality and cost-effectiveness of medicine use, thereby improving patient care. DUE programs are seen as an essential component of pharmacy service provision and are now an integral part of pharmacy services, especially in medium-to-large public hospitals, where they provide a valid and powerful weapon to ensure that drug expenditure is both effective and effi- cient. In the introduction to the standards of practice, the authors state: ‘...DUE may be applied to a drug, therapeutic class, dis- ease state or condition, a drug use process or specific outcomes...[and] may be applied in various practice settings includ- ing hospitals, other health facilities and community practice environments...’. (The document notes that in Australia the terms DUE and drug use review (DUR) are used interchangeably. However, DUE is now the preferred term and is the one used exclusively in the Standard.) The objectives of a DUE program is to improve the quality, safety and cost-effec- tiveness of medication use by: facilitating a multidisciplinary consensus on drug use; conducting regular audits to assess con- cordance; providing feedback of results to stakeholders; promoting judicious, appro- priate, safe and cost effective therapy through provision of information, advice and education; minimising variations in practice that contribute to sub-optimal hospital talk John Low, hospital pharmacist Standards of practice for drug use evaluation outcomes; and, assessing the value of drug use practices. In essence, a DUE program is based on the traditional quality assurance cycle of monitoring, assessing, acting and evaluat- ing where all segments of the cycle are undertaken against authoritative drug use criteria. To be effective, such programs must be part of a systemic and multidisci- plinary approach involving all those with an interest in drug therapy (prescribers, pharmacists, nurses, managers, con- sumers) and must be given legitimacy and authority within an organisation. The involvement of the institutional committee responsible for regulating drug use (a drug and therapeutics committee, however named), together with clear lines of communication with other quality improvement committees within an insti- tution, are critical to the success of any DUE program. The importance of these factors cannot be overstated. Another important aspect of DUE pro- grams is their targeting. Certain drugs or events serve as indicators of potential problems in the drug use process and may highlight potential target area. They may include: drugs known to be associated with adverse events or poor patient out- comes; drugs used in high use patients; drugs with high associated costs (whether the result of high volume or high unit cost); or drugs where sub-optimal use is likely to have an adverse affect on patient outcomes. Pharmacists, by virtue of their expertise and mission of ensuring quality use of medicines, are well placed to play a lead- ership role in DUE programs and to work collaboratively with other stakeholders. Opportunities for the involvement of the pharmacist may include: program devel- opment, supervision and coordination; education of hospital staff involved in 88 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 FEBRUARY 2005 Drug use evaluation programs...should be seen as a vehicle promoting quality assurance in drug use medication management about the the- ory and practice of DUE; coordination of data collection, analysis and recommen- dations for intervention; documentation of program effectiveness; and presenta- tion of DUE findings at meetings and con- ferences. It is important that DUE programs achieve a balance between the quantita- tive and the qualitative; that the programs are not introduced into institutions on the understanding that the savings that would be generated would exceed the cost of the program. DUEs quite clearly should be seen as a vehicle promoting quality assurance in drug use rather than merely a vehicle for cost minimisation. There are significant pressures within Australian public hospitals as, on one hand, more is being demanded of our health dollar while, on the other, con- sumers of our services demand access to the latest in medical (drug) technology. While pharmacists can do little in absolute terms to reduce the demand for the latest in drug technology, they are able through DUE programs and the like, to ensure drugs are be used efficiently and effectively. 1. SHPA Committee of Specialty Practice in Drug Use Evaluation. SHPA Standards of Practice for Drug Use Evaluation in Australian Hospitals. J Pharm Pract Res 2004;34:220–3. ¦