Academic journal article American Journal of Pharmaceutical Education

"Brown Bag" Simulations to Teach Drug Utilization Review

Academic journal article American Journal of Pharmaceutical Education

"Brown Bag" Simulations to Teach Drug Utilization Review

Article excerpt

INTRODUCTION

Drug utilization review has been a standard part of pharmacists' practice for many years. (1) Drug utilization review is used to assess drug therapy appropriateness and ensure patient safety. (2) The Institute for Safe Medication Practices encourages the use of "brown-bag" checkups by pharmacists as a safety measure to check for problems such as drug-allergy contraindications, therapeutic duplication, drug-drug interactions, drug-disease interactions, inappropriate dosage or duration of therapy, or clinical abuse and misuse. For a brown-bag checkup, the patient brings all prescription and nonprescription medications to a pharmacist and has him or her review them for any potential problems. (3) The brown bag review process has been developed and used in the Creighton University School of Pharmacy and Health Professions' skills laboratory program for the specific purpose of having students apply principles of DUR without the assistance of a technical interface.

Drug utilization review involves the review of a prescription prior to dispensing a drug to the patient. This review includes such activities as screening for drug-disease contraindications and drug-drug interactions. (4) Most pharmacies have systems that alert the pharmacist to a potential problem before the prescription is dispensed. However, it is important that pharmacists have the professional knowledge and judgment necessary to conduct a prospective DUR without the aid of a computer program. To conduct a DUR, the pharmacist must consider and be able to judge these elements: prescription accuracy; allergies; medication appropriateness; dosage and length of therapy; drug interactions (including drug-drug, drug-disease, drug-food, and drug-laboratory); therapeutic duplication; appropriate use; adverse effects; and abuse or misuse. (2)

The Omnibus Budget Reconciliation Act of 1990 (OBRA '90) created a requirement for states to ensure prospective drug review occurs with every dispensed prescription reimbursed by government programs:

"The State plan shall provide for a review of drug therapy before each prescription is filled or delivered to an individual receiving benefits under this subchapter, typically at the point-of-sale or point of distribution. The review shall include screening for potential drug therapy problems due to therapeutic duplication, drug-disease contraindications, drug-drug interactions (including serious interactions with nonprescription or over-the-counter drugs), incorrect drug dosage or duration of drug treatment, drug-allergy interactions, and clinical abuse/misuse." (5)

Most states have implemented statutes and regulations that require the same type of prospective DUR for all prescriptions regardless of the type of reimbursement. Additionally, several pharmacy organizations have enacted codes of ethics and standards of practice that support this view of DUR. These include the American Pharmacists Association, the American Society of Health-Systems Pharmacists, the National Association of Boards of Pharmacy, and the Academy of Managed Care Pharmacy. (2)

The American Association of Colleges of Pharmacy's Pharmacy Practice Supplemental Educational Outcomes, which are based on CAPE 2004, specifically state: "Interpret and evaluate patient and drug-related data needed to identify actual or potential drug therapy problems (prescription and non-prescription)". (6) Under this heading, the following activities are listed: assess any patient history of allergies and intolerances, evaluate the significance of actual or potential drug interactions, assure that there is not excessive medication use or unnecessary drug duplication, and identify signs or potential indicators of drug misuse or abuse.

The previous pharmacy curriculum at the School of Pharmacy and Health Professions at Creighton University had limited student exposure to developing and improving DUR skills prior to the fourth year, with that occurring only in the classroom during the sixth semester of the program. …

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