Evaluation Of Medication Use Research Articles

ASHP national survey of pharmacy practice in hospital settings: Prescribing and transcribing—2004

Results of the 2004 ASHP national survey of pharmacy practice in hospital settings that pertain to prescribing and transcribing are presented. A stratified random sample of pharmacy directors at 1183 general and children's medical-surgical hospitals in the United States was surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database. The response rate was 41.7%. Compared with the results of the 2001 survey, the number of times pharmacy and therapeutics committees met increased, suggesting an increase in efforts to monitor and manage medication use in hospitals. There was an increase in the use of quality-of-life information to make formulary decisions, indicating a shift away from cost-based formularies. There was a decrease in the rates of formulary compliance, but an increase in the use of evidence-based clinical practice guidelines, suggesting the emergence of more comprehensive approaches to improving prescribing. The use of medication-use evaluations increased in smaller hospitals, suggesting greater use of best practices is occurring in these institutions. The use of drug information services continues to decline, as the use of more efficient and easily accessible online sources of drug information increases. Reading back oral orders to improve accuracy dramatically increased since 2001. The adoption of computerized prescriber-order-entry systems continues to be slow, with fewer than 5% of hospitals reporting their use. The 2004 ASHP survey results indicate that pharmacists are continuing to improve medication use at the prescribing and transcribing steps of the medication-use system.

ASHP national survey of pharmacy practice in hospital settings: Prescribing and transcribing—2004

Purpose. Results of the 2004 ASHP national survey of pharmacy practice in hospital settings that pertain to prescribing and transcribing are presented. Methods. A stratified random sample of pharmacy directors at 1183 general and children’s medical–surgical hospitals in the United States was surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG’s hospital database. Results. The response rate was 41.7%. Compared with the results of the 2001 survey, the number of times pharmacy and therapeutics committees met increased, suggesting an increase in efforts to monitor and manage medication use in hospitals. There was an increase in the use of quality-of-life information to make formulary decisions, indicating a shift away from cost-based formularies. There was a decrease in the rates of formulary compliance, but an increase in the use of evidence-based clinical practice guidelines, suggesting the emergence of more comprehensive approaches to improving prescribing. The use of medication-use evaluations increased in smaller hospitals, suggesting greater use of best practices is occurring in these institutions. The use of drug information services continues to decline, as the use of more efficient and easily accessible online sources of drug information increases. Reading back oral orders to improve accuracy dramatically increased since 2001. The adoption of computerized prescriber-order-entry systems continues to be slow, with fewer than 5% of hospitals reporting their use. Conclusion. The 2004 ASHP survey results indicate that pharmacists are continuing to improve medication use at the prescribing and transcribing steps of the medication-use system.

SHPA Standards of Practice for Drug Use Evaluation in Australian Hospitals: SHPA Committee of Specialty Practice in Drug Use Evaluation

Journal of Pharmacy Practice and ResearchVolume 34, Issue 3 p. 220-223 Practice StandardFree Access SHPA Standards of Practice for Drug Use Evaluation in Australian Hospitals: SHPA Committee of Specialty Practice in Drug Use Evaluation Paula Doherty, Paula Doherty (Chairman)Search for more papers by this authorSue Kirsa, Corresponding Author Sue Kirsa (Convenor)Sue Kirsa, Austin Health, 145 Studley Road, Heidelberg Vic. 3084, Australia E-mail: sue.kirsa@austin.org.auSearch for more papers by this authorSarah Chao, Sarah ChaoSearch for more papers by this authorStephanie Wiltshire, Stephanie WiltshireSearch for more papers by this authorDavid McKnight, David McKnightSearch for more papers by this authorDavid Maxwell, David MaxwellSearch for more papers by this authorJonathan Dartnell, Jonathan DartnellSearch for more papers by this authorKaren Kaye, Karen KayeSearch for more papers by this authorLinda Graudins, Linda GraudinsSearch for more papers by this author Paula Doherty, Paula Doherty (Chairman)Search for more papers by this authorSue Kirsa, Corresponding Author Sue Kirsa (Convenor)Sue Kirsa, Austin Health, 145 Studley Road, Heidelberg Vic. 3084, Australia E-mail: sue.kirsa@austin.org.auSearch for more papers by this authorSarah Chao, Sarah ChaoSearch for more papers by this authorStephanie Wiltshire, Stephanie WiltshireSearch for more papers by this authorDavid McKnight, David McKnightSearch for more papers by this authorDavid Maxwell, David MaxwellSearch for more papers by this authorJonathan Dartnell, Jonathan DartnellSearch for more papers by this authorKaren Kaye, Karen KayeSearch for more papers by this authorLinda Graudins, Linda GraudinsSearch for more papers by this author First published: 01 September 2004 https://doi.org/10.1002/jppr2004343220Citations: 20AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1Shaw PM, Gayman JE, Todd MW. ASHP Guidelines on medication-use evaluation. Am J Health Syst Phann 1996; 53: 1953– 5 2 The Society of Hospital Pharmacists of Australia. Australian Drug Usage Evaluation Starter Kit, 1998 3 The Society of Hospital Pharmacists of Australia. Committee of Specialty Practice in Drug Use Evaluation. SHPA standards of practice for drug use evaluation in Australian hospitals. Aust J Hosp Phann 1996; 26: 240– 6 4Dartnell JGA. Understanding, influencing and evaluating drug use. Melbourne: Therapeutic Guidelines Ltd; 2001 5Stolar MH. Drug use review: operational definitions. Am J Hosp Pharm 1978; 35: 76– 8 6 Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists. Drug Use Evaluation Network. Development of drug usage evaluation in hospital practice in Australia and New Zealand, 1998 7 NSW Health. Easy guide to clinical practice improvement: a guide for healthcare professionals. Sydney: NSW Health Department; 2003 8 P Carver, editor. Breakthrough series guides. Boston: Institute for Healthcare Improvement; 1998 9 National Health and Medical Research Council. When does quality assurance in health care require independent ethical review? Canberra: The Council; 2003 10McGuire TM, Petrie GM. A hitchhiker's guide to establishing a drug utilisation evaluation program. Aust J Hosp Pharm 1995; 25: 315– 23 11Plumridge RJ. Intervention strategies aimed at modifying prescribing behaviour. Aust J Hosp Phann 1984; 14: 93– 100 12Ioannides-Demos L, Eckert GM, Mclean AJ. Pharmacoeconomic consequences of measurement and modification of hospital drug use. Phannacoeconomics 1992; 2: 15– 33 13Dartnell JGA. Activities to improve hospital prescribing. Aust Prescr 2001: 24: 29– 31 14 Australian Government Department of Health and Ageing. Australian Statistics on Medicines, 1999–2000. Canberra: The Department; 2003 Citing Literature Volume34, Issue3September 2004Pages 220-223 ReferencesRelatedInformation

Advances in postoperative pain management: the pharmacy perspective.

The pharmacist's role in promoting proper use of analgesic drug therapies, by ensuring that Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards for pain management are met, evaluating new analgesic options for formulary addition, and conducting medication-use evaluations, outcomes research, and pharmacoeconomic analyses, is discussed. Pharmacists can be instrumental in meeting JCAHO requirements for educating clinical staff and patients about pain management practices and monitoring compliance with JCAHO pain management standards. They also can thoroughly evaluate new analgesic drug therapies and delivery systems for formulary addition by reviewing published literature and manufacturers' data and conducting medication-use evaluations, outcomes research, and pharmacoeconomic analyses. Cost-effectiveness analysis is the most common among the four types of pharmacoeconomic analyses, which include cost-minimization analysis, cost-benefit analysis, and cost-utility analysis. A ten-step process is used in conducting pharmacoeconomic analyses to increase the validity of the results. Implementation of new analgesic drug delivery technologies, such as an elastomeric infusion pump (a device for continuous wound infiltration with a local anesthetic), a needle-free transdermal patient-controlled analgesia system, and a new sustained-release, liposome-encapsulated form of morphine for epidural injection, offers new postoperative pain management alternatives for patients and clinical staff and involves unique considerations for pharmacists.

Expert consensus-based medication-use evaluation criteria for atypical antipsychotic drugs

Medication-use criteria for the appropriate use of atypical antipsychotics were developed through a national consensus process utilizing an expert panel. A written survey was prepared which asked for opinions about options for psychopharmacologic interventions with seven antipsychotic drugs or categories (clozapine, olanzapine, quetiapine, risperidone, ziprasidone, long-acting intramuscular decanoate ester preparations of conventional antipsychotics, and oral conventional antipsychotics) in 19 specific clinical situations. The survey was sent to 50 psychiatrists and psychiatric pharmacist specialists, 42 (84%) of whom completed the survey. The survey was formatted as a grid with rows listing various clinical situations and columns itemizing the various antipsychotic medications relevant to the situations. Responses were scored using a 9-point scale for rating the level of medical review required for any given decision. Consensus on each option was defined as a nonrandom distribution of scores by a chi-square goodness-of-fit test. Consensus was reached for 1179 of the 1230 items reviewed. Use of clozapine as a first-line therapy warranted prospective or mandated review for all diagnoses. Use of nonclozapine atypical agents for schizophrenia and schizoaffective and delusional disorders was judged to be the standard of care. Oral conventional antipsychotic agents were not considered the standard of care for any indication. Combination antipsychotic treatment always warranted at least concurrent review. Continued concerns about the use of ziprasidone and its cardiac effects were apparent. This study demonstrated the utility of a consensus-based process in addressing issues and practices not adequately addressed in the scientific literature.

Phytonadione Education Program in a Community Hospital

PurposePharmacists and physicians were educated regarding updated guidelines on phytonadione indications, dosing, and routes of administration. Study objectives were to evaluate the use of phytonadione in a community hospital, educate pharmacists and physicians about phytonadione use, and assess the value of education in terms of patient outcomes.MethodsBaseline and follow-up data on phytonadione indications, dosages, and routes of administration were collected. Pretests and post-tests were administered before and after an education session. A Pharmacy and Therapeutics newsletter article highlighting the appropriate use of phytonadione was published.ResultsThe baseline and follow-up medication use evaluations (MUEs) revealed that 53% and 62% of patients had an appropriate indication for phytonadione, respectively (P = 0.181). Among patients with an appropriate indication, 44% were administered an appropriate dose in the baseline group and 46% in the follow-up (P = 0.876). The baseline MUE revealed that 20% of phytonadione routes of administration were appropriate; 18% were considered appropriate in the follow-up (P = 0.842). Pharmacists' knowledge showed improvement after education efforts, with the mean score improving from 57% to 93.4% from pretest to post-test (P < 0.05) and the median score changing from 50% to 100%.ConclusionImproving pharmacists' knowledge is beneficial and necessary; however, it was not enough to change practice in this study. Additional steps must be taken to encourage routine application of the knowledge.

ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing--2001.

Results of the 2001 ASHP national survey of pharmacy practice in hospital settings that pertain to prescribing and transcribing are presented. A stratified random sample of pharmacy directors at 1091 general and children's medical-surgical hospitals in the United States was surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database. The response rate was 49.0%. During 2001, nearly all hospitals are estimated to have pharmacy and therapeutics (P&T) committees that meet an average of seven times per year. It is estimated that more than 90% of P&T committees are responsible for formulary development and management, drug policy development, adverse-drug-reaction review, and medication-use evaluation. More than 90% of hospitals use clinical and therapeutic, cost, and pharmacoeconomic information in the formulary management process, while nearly two thirds consider quality-of-life issues. Nearly 70% use clinical practice guidelines in the formulary management process, and 78% have a medication-use evaluation program designed to improve prescribing. Pharmacists in more than 75% of hospitals provide consultations on drug information, dosage adjustments for patients with renal impairment, antimicrobials, and pharmacokinetics. Further, a majority of hospitals ensure accurate transcription of medication orders by clarifying illegible orders before transcription or entry into medication administration records (MARs), using standardized prescriber order forms, requiring prescribers to countersign all oral orders, and reconciling MARs and pharmacy patient profiles at least daily. In 2001, large hospitals are most likely to use prescriber order-entry systems to improve patient safety and are least likely to require the reentry of medication orders into the pharmacy computer system. The 2001 ASHP survey results suggest that pharmacists in hospital settings have positioned themselves well to improve the prescribing and transcribing components of the medication-use process.

Patient outcomes can be improved by proper application of the medication-use evaluation (MUE) process,

Patient outcomes can be improved by proper application of the medication-use evaluation (MUE) process,

Criteria for the Use of Tramadol in Adult Patients: Medication-Use Evaluation Guidelines

OBJECTIVE: To develop a practical medication-use evaluation (MUE) tool flexible enough to be used in a variety of practice settings. SETTING: Institutional health care systems or managed care organizations, although the format may be adapted for use by consultant pharmacists. DESIGN: This MUE has been designed for use as part of a comprehensive outcome monitoring program. It focuses on a particular agent (tramadol hydrochloride) that has significant cost and usage implications. MAIN OUTCOME MEASURES: Appropriate patient populations and desired therapeutic outcomes can be identified with the use of this MUE. Customized interventions that are appropriate to each organization may. RESULTS: This MUE can provide a framework for institutional health care systems and' MCOs to use in developing a comprehensive monitoring program for tramadol hydrochloride and an oral analgesic. CONCLUSION: Effective high-quality pharmaceutical care incorporates the use of assessment methods that monitor patient outcomes and medication-use processes. Patient outcomes may be improved through proper application of the MUE process.

A Medication Use Evaluation of Adverse Events Associated with Colony-Stimulating Factor Therapy

A retrospective medication use evaluation (MUE) was used to determine the comparative incidence of adverse events in patients treated with colony-stimulating factors (CSFs). CSFs are high-cost, high-volume medications in our practice setting, and the incidence of side effects is an important factor that influences our physicians when they choose a CSF. Data collection elements were selected by key pre-scribers, and the MUE was conducted under the authority of the Pharmacy and Therapeutics Committee. The medical records of 30 patients treated with sargramostim and 30 patients treated with filgrastim were reviewed by a pharmacist. The incidence and severity of adverse events and selected clinical outcomes were found to be similar in the two groups. It was concluded that differences in adverse event profiles should not be used to differentiate CSFs. The MUE results were used to educate physicians regarding the differences and similarities of CSFs and to encourage use of the preferred agent, sargramostim.

ASHP national survey of pharmacy practice in acute care settings: prescribing and transcribing--1998. American Society of Health-System Pharmacists.

Results of the 1998 ASHP national survey of pharmacy practice in acute care settings that pertain to prescribing and transcribing practices are presented. Pharmacy directors at 1058 general and children's medical-surgical hospitals in the United States were surveyed by mail. Data on hospital characteristics were supplied by SMG Marketing Group, Inc.; the survey sample was drawn from SMG's hospital database. The response rate was 51.8%. Respondents reported that at least 90% of hospital and health-system pharmacy and therapeutics (P&T) committees are responsible for formulary development and management, drug policy development, medication-use evaluation, adverse-drug-reaction reporting, and medication error monitoring. More than 90% of the facilities use pharmacoeconomic, clinical and therapeutic, and cost information in formulary development; 83% have a medication-use-evaluation program designed to improve prescribing; more than 95% have P&T committees, infection control committees, and quality control committees; and more than 80% provide pharmacist consultations on drug information, dosage adjustments for patients with renal impairment, antimicrobials, and pharmacokinetics. A majority of respondents reported that accurate transcription of medication orders is ensured by use of standardized physician order forms, clarification of illegible orders, reconciliation of medication administration records (MARs) and pharmacy profiles at least daily, and use of computer-generated MARs. The 1998 ASHP survey results suggest that pharmacists in acute care settings have positioned themselves well to improve the prescribing and transcription components of the medication-use process.

PMD5 Prescription Medication Use in Older Americans

Medication use is under-investigated in the 50 and older population. OBJECTIVE: We used data from the 1995 National Ambulatory Medical Care Survey (NAMCS) to evaluate prescription medication use in older Americans. METHODS: NAMCS is a nationally representative sample of ambulatory care visits in the United States and contains clinical information concerning each visit, including medication. Non-prescription products and medications typically administered during a physician office visit or hospitalization were excluded from analysis; all other medications were considered prescription medications and eligible for evaluation. We evaluated patients 50 years or older (n = 16,289 visits) and report prescription use by age group and therapeutic and drug class. Analysis is based on NAMCS weighted data. RESULTS: 61% of patient visits included renewal or prescription of at least one medication. Prescription medication use ranged from x = 1.27 prescription medications in patients aged 50–64 to x = 1.58 in patients over 85. Most commonly prescribed therapeutic classes were cardiovascular, pain/anti-inflammatory, anti-microbial, central nervous system, and hormone agents. Most commonly prescribed drug classes were non-narcotic analgesics, calcium channel blockers (CCB), diuretics, and angiotensin converting enzyme (ACE) inhibitors. We observed greater use of CCB than beta blockers and diuretics in patients younger than 75 and a significant decrease in estrogen/progestin and antidepressant medication use in older patients. CONCLUSION: We report a cross-sectional evaluation of medication use in the US population 50 and older. Our findings indicate prescribing patterns inconsistent with national guidelines (JNC-V). Given the benefits of estrogen replacement therapy and high prevalence of depression in the elderly, decreased medication use may suggest underprescription. Active intervention may be needed to improve the pharmacological treatment of older patients.