CONCURRENT UTILIZATION REVIEW

Concurrent Utilization Review

Concurrent Utilization Review

Introduction

Implementation of hospital drug formulary systems helps to optimize treatment, make essential drugs available, and control costs of therapy. The drug formulary can be considered the basis of rational drug use. However, the existence of a rationally derived list of drugs approved for procurement and use in a hospital does not ensure that they are prescribed and used correctly. One mechanism to ensure correct prescribing and use is the drug utilization review (DUR) process; although often considered a component of a drug formulary system, DUR programs can exist in the absence of other formulary activities.

DUR programs should be carefully planned by the medical staff to include the drugs considered to be most problematic if not used correctly. By comparing actual drug use to predetermined standards, DUR can detect inappropriate and/or unnecessarily costly drug therapy. Programs can be designed to monitor individual drugs, or drug classes, as well as to monitor drug use in specified diseases. Most of the examples used in this guide are related to DUR for individual drugs. When problems are identified, interventions are designed and implemented to improve drug use. Interventions can include educational programs, provision of drug information, changes in hospital policies and procedures, and changes in the drug formulary.

Form the DUR Committee

As with the development and maintenance of hospital formularies, DUR is primarily a medical staff function, with pharmacists and nurses providing valuable expertise. In a hospital setting, the body responsible for planning and implementing a drug utilization review program is the DUR Committee. If a Hospital Formulary Committee already exists, they may be given responsibility for DUR, or they may form a DUR subcommittee. Regardless of the structure, the body responsible for DUR should be composed of professionals with an interest in improving drug therapy in the hospital, and have ready access to experts in medicine, surgery, and all major hospital specialties. The DUR committee should establish and maintain adequate means of communication with the hospital administration and other relevant hospital committees. The most critical task of the DUR Committee is the development or selection of the criteria that will serve as the basis for monitoring, evaluation, and interventions, which are described in Step 7. The committee may require input from a variety of hospital specialists in this step. As discussed in Annex One “The Importance of Clinical Pharmacology,” the success of DUR as a means to improving drug use and controlling costs depends largely on the active participation of physicians, clinical pharmacologists, or clinical pharmacists with detailed, current knowledge of pharmacotherapy and pharmacokinetics.

Write Policies and Procedures

Prior to monitoring and evaluation, the committee should draft and approve the policies and procedures that will govern its work. Inclusion of a clear statement of the goals and major activities of the committee is important because dissemination of the policies and procedures may be used as a means of educating hospital personnel about the program. Below are key elements recommended for inclusion in DUR policies and ...