8. DRUG UTILIZATION EVALUATION AND REVIEW (DUR)

Drug Utilization Evaluation and Review (DUR) is an essential clinical pharmacy activity that promotes the safe, effective, and appropriate use of medications. DUR programs analyze prescribing patterns, medication use processes, and clinical outcomes to identify areas for improvement. Through continuous monitoring and evaluation, DUR enhances rational drug therapy, reduces medication errors, supports formulary management, and improves overall patient care.

What Is Drug Utilization Evaluation (DUE) / Drug Utilization Review (DUR)?

Drug Utilization Evaluation (DUE) and Drug Utilization Review (DUR) refer to systematic, criteria-based evaluation of medication use to ensure that drugs are used safely and appropriately. DUR identifies problems in prescribing, dispensing, and patient use of medications and recommends corrective actions.

Objectives of DUR / DUE

  • Promote rational and evidence-based medication use.
  • Improve clinical outcomes and patient safety.
  • Identify medication errors, drug interactions, and inappropriate therapy.
  • Monitor high-risk or high-cost medications.
  • Support formulary decisions and guideline development.
  • Evaluate adherence to hospital protocols and treatment standards.
  • Reduce avoidable healthcare costs related to drug misuse.

Types of DUR

1. Prospective DUR

Conducted before the medication is dispensed. The pharmacist evaluates:

  • Drug allergies
  • Appropriate dose and frequency
  • Drug–drug interactions
  • Duplicate therapy
  • Contraindications

2. Concurrent DUR

Occurs during the course of therapy. It involves:

  • Monitoring patient response
  • Adjusting therapy based on lab results
  • Identifying emerging drug interactions
  • Preventing adverse drug events (ADEs)

3. Retrospective DUR

Conducted after the therapy is completed. It includes:

  • Reviewing patient medical records
  • Assessing appropriateness of therapy
  • Evaluating adherence to guidelines
  • Identifying trends in drug use

Steps in DUR Process

1. Identify the Drug or Medication Class for Review

  • Select high-risk, high-cost, or frequently used medications.
  • Example: antibiotics, anticoagulants, insulin, opioids.

2. Develop Review Criteria and Standards

Criteria are based on:

  • Clinical guidelines
  • Evidence-based literature
  • Hospital protocols
  • Formulary restrictions

3. Collect Data

  • Patient demographics
  • Indications for therapy
  • Drug dosage, frequency, and duration
  • Lab results and clinical outcomes
  • Documentation of adverse events

4. Analyze and Interpret Data

  • Compare actual drug use with established criteria.
  • Identify drug-related problems (DRPs).
  • Evaluate adherence to standard treatment guidelines.

5. Intervene and Take Corrective Action

  • Provide recommendations to prescribers.
  • Modify inappropriate prescriptions.
  • Educate staff on best practices.
  • Implement system-level changes if required.

6. Monitor Outcomes and Follow-Up

  • Track improvements in drug use.
  • Measure patient outcomes and safety indicators.
  • Repeat the cycle if needed.

Indicators Used in Drug Utilization Evaluation

  • Prescribing indicators: generic prescribing rate, antibiotic use, polypharmacy.
  • Patient-care indicators: counseling provided, medication adherence.
  • Facility indicators: availability of essential medicines, storage conditions.

Common Drug-Related Problems Identified During DUR

  • Incorrect dose or frequency
  • Unnecessary or duplicate therapy
  • Potential or actual drug interactions
  • Contraindicated medications
  • Failure to monitor required lab parameters
  • Poor patient adherence
  • Inappropriate antibiotic use leading to resistance

Role of Clinical Pharmacists in DUR

  • Lead and coordinate DUR programs.
  • Develop criteria and review protocols.
  • Evaluate medication charts and lab results.
  • Identify and resolve drug-related problems.
  • Provide educational sessions for healthcare staff.
  • Ensure adherence to hospital guidelines.
  • Document interventions and monitor outcomes.

Benefits of DUR

  • Reduces medication errors and ADRs.
  • Improves therapeutic effectiveness.
  • Ensures cost-effective medication use.
  • Strengthens pharmacovigilance systems.
  • Improves antibiotic stewardship.
  • Enhances quality of prescribing and dispensing.

Challenges in Implementing DUR

  • Limited pharmacist staffing.
  • Inadequate access to patient records.
  • Resistance from prescribers due to workflow interruptions.
  • Lack of hospital-level policies and support.
  • Insufficient training in data analysis tools.

Detailed Notes:

For PDF style full-color notes, open the complete study material below:

Share your love