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Drug Use Evaluation

Drug Use Evaluation. Judith Coombes- Senior pharmacist PAH, conjoint lecturer UQ. Objectives. introduce quality cycle DUE and evidence based medicine DUE cycle steps of DUE. Quality CYCLE. PLAN. ACT. CHECK. DO. DUE CYCLE. COLLECT DATA. ACTION. FEEDBACK. FEEDBACK EVALUATED

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Drug Use Evaluation

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  1. Drug Use Evaluation Judith Coombes- Senior pharmacist PAH, conjoint lecturer UQ

  2. Objectives • introduce quality cycle • DUE and evidence based medicine • DUE cycle • steps of DUE

  3. Quality CYCLE PLAN ACT CHECK DO

  4. DUE CYCLE COLLECT DATA ACTION FEEDBACK FEEDBACK EVALUATED DATA EVALUATE DATA

  5. CHECK = AUDIT= COLLECT DATA AND EVALUATE

  6. What is a DUE programme? • really a quality assurance programme specific to medications • Promote QUM (via a partnership) • Judicious • appropriate • safe • effective -improve quality of life

  7. JudiciousAppropriateSafe effectiveacceptable to patient(BARBER) • daily commitment of the pharmacist so what is different

  8. QUM/Pharmaceutical care is patient orientated at the individual level • ‘achieving definite outcomes that improve patients quality of life’ Hepler, Strand 1990 • DUE is Drug/Disease orientated at the hospital (or even country) wide level

  9. Why have DUE? • Clinical benefits • Evidence based medicine • Educational benefits • Economic benefits

  10. Clinical benefits • Evaluate outcome • nausea and vomiting-nausea diary • pain control-pain scales • incidence of DVT • reduce adverse effects • Thrombocytopenia with heparin • Reduce antibiotic resistance • Reduce risks of infection if IV route not needed

  11. Evidence Based medicine Clinical Expertise Patient Values Decision Best research evidence

  12. Evidence Based Medicine FIVE STEPS • Answerable question • best current evidence • validity, impact, applicability • integrate with clinical expertise • evaluate performance

  13. Educational Benefits • Pharmacists collecting data improve clinical skills • Calculate PSI • Use pain scores • Junior Doctors • learn during data collection (dose, duration) • Consultants, Prescribers, Pharmacists, nurses, others involved • feedback-grand rounds, bulletins, prescribing guidelines, academic detailing

  14. Economic benefits • potential to identify efficiencies (often duration reduced) • potential to justify expenditure • step back to hospital costs rather than drug costs (EG Low Molecular Weight Heparin) • identify outcome benefits

  15. Who is involved in DUE? • DUE pharmacist/Post Grad/Project • QUM projects in 4th year • Clinical Pharmacists • The whole pharmacy department. • Prescribers/consultants • Nurses • Patients • Drug and Therapeutics committee • National Prescribing Service in Australia

  16. Examples • Community Acquired Pneumonia in Australian Hospitals (CAPTION) • Acute Post operative pain (APOP) • Deep Vein Thrombosis prophylaxis in hospital • Discharge Medication for Acute Coronary Syndrome (DMACS)

  17. DUE STEPS(Australian Drug usage evaluation starter kit, The Society of Hospital Pharmacists, Melbourne 1998) 1-make a start (who will support you) 2-identify drugs/areas of practice for review (examples; Vancomycin, Community acquired pneumonia, Pain, DVT prophylaxis) 3-critical literature evaluation (EBM) 4-define criteria 5-Data collection form 6-collect data

  18. DUE CYCLE COLLECT DATA ACTION FEEDBACK FEEDBACK EVALUATED DATA EVALUATE DATA

  19. STEPS in DUE (starter kit) 7-evaluate 8-feedback evaluated data 9-Action 10-Assess results of repeat data collection 11-Report, Publish, Present 12-Monitor and re-evaluate regularly

  20. Community Acquired Pneumonia Feedback reported on Areas we could build upon: • PSI calculation and documentation, 35% is a good start but can be improved upon. • 4/7 (57%) of class 1 and 2 patients prescribed IV antibiotics unnecessarily. .

  21. Baseline • Detailing and feedback • Re-audit • Detailing and feedback • Re-audit • Conference presentation • MJA article • Maxwell DJ, McIntosh KA, Pulver LK, Easton KL for the CAPTION Study Group. Empiric management of community-acquired pneumonia in Australian emergency departments. Medical Journal of Australia 2005;183: 520-524

  22. INVOLVEMENT IN A NATIONAL MULTICENTRE DUE –An evaluation by APOP participating Queensland hospitalsDonna R Taylor, Lisa K Pulver, Susan E Tett, Judith A Coombes.School of Pharmacy University of Queensland • Key messages: • Previous project participation informs accuracy of estimate of resource allocation • Team approach most effective, least draining • Hard copy project manual used more than website • Support and accessibility of state project officer highly valued • NPS material highly regarded • Positive hospital impact at all sites • 100% of participants reported positive personal outcomes Background: 14 hospitals participated in the Queensland arm of the national NPS-funded Acute Postoperative Pain project (APOP). Participants were invited to a state project wrap-up meeting to facilitate project de-briefing. • Results: • Response rate of 100%, • comprised equally of Pharmacy and Nursing • Previous participation in a QI project* - 36% • Aware of time commitment * - 36% • (*Strong correlation) • Time frame‘about right’ - 58% • Materials • NPS Feedback useful/very useful - 85% • NPS Feedback used to • inform Academic Detailing - 100% • customise Power Point presentation - 92% • Quality of material - good or excellent - 100% • Used manual - 86% • Used website - 71% Conclusion: Project evaluation by the participants provided valuable project de-briefing and useful management information for future national multicentre projects. The experience from all hospitals was very positive, and is encouraging for future participation in planned national multi-site DUEs. Acknowledgements: Our grateful thanks for the development of the evaluation toolto the state-based DUE group in Victoria, and for the supportprovided by NPS and all state-based DUE groups - NSW, Tasmania, South Australia and Victoria. And to the participating Qld hospitals for their significant efforts and achievements in improving the quality of patient care – Greenslopes Private, Ipswich, Logan, Nambour, Mater Mothers Private, Mater Public, Princess Alexandra, Redcliffe, Caboolture, Redland, Royal Brisbane and Women’s, Royal Darwin, Toowoomba and Wesley Private Hospitals. PERCEIVED LEVEL of SUPPORT Aim: To evaluate the experience of participants in a national multi-centre DUE. Method: Participating hospitals were requested to complete a project evaluation questionnaire prior to the meeting, for presentation on the day. • A positive impact at the hospital - 100% • wrt specific project aims - ~50% • (pain documentation, education, prescribing) • on the hospital dynamic - ~50% • (collaboration/communication/teamwork) • A positive impact on the participant- 100% • Increased confidence • Increased project and people management skills • Satisfaction in effecting behaviour change • Satisfaction in collaboration The Queensland Team

  23. DUE CYCLE COLLECT DATA ACTION FEEDBACK FEEDBACK EVALUATED DATA EVALUATE DATA

  24. DUE Studies • NSAIDs in the community (GP and Pharmacist) • Antibiotics in Community acquired pneumonia • Vancomycin • Antiemetics in Chemotherapy • DVT Prophylaxis • UTI management • Secondary prevention post MI • Aspirin use as secondary prevention of MI in the community • Antibiotic prophylaxis in surgery • Benzodiazepine use • National Prescribing Service DUEs/Audits

  25. Limitations • methodology • levels of evidence, Cochrane Collaboration • Systematic review- level 1 • RCT- level 2 • cohort level 3 or 4 • Ideal outcome impractical to measure • resources (time and personnel)-now breakthrough method sometimes used • tip of the iceberg • incomplete/ not completable

  26. Conclusion • DUE is for everyone • DUE is not research in its purest form BUT • DUE is a way of changing practice

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