Communication strategies to improve drug use evaluation

Successful examples of teams and drug use evaluations explore communication strategies to enhance quality improvement of medication use. Topics highlighted include establishing contacts within key departments, creating committee connections, fostering physician and nurse participation, and increasing visibility and maintaining awareness. Multidisciplinary collaboration and linkage between the hospital and the managed care pharmacy are also reviewed. Medication use can be improved by integrating these communication tactics.     

Practice guidelines and drug-usage evaluation

Currently, there is a great deal of interest in the development of practice guidelines for medical care that will be more rigorous and clinically sound than what is available today. With the impetus of federal legislation mandating such an approach, it may continue to develop into a significant movement in the medical arena. Pharmacy managers should be aware of developments in this area, particularly as they relate to appropriateness of drug therapy and drug-utilization review. The result may eventually be an evolution from drug-utilization review programs to diagnosis-based, outcome-focused interdisciplinary systems for QA. Even with the development of practice guidelines as described, there will continue to be a need for competent pharmacy practitioners to ensure appropriate pharmaceutical care. With the increasing acuity of patients in the health care system and the rapid development of new drugs and technologies, the role of the institutional pharmacist in ensuring optimal patient care will be more important than ever.     

Organizing for drug-usage evaluation

Because QA is the chief interest of the Joint Commission, hospital pharmacists must strive to have a well-organized DUE plan and process. However, merely satisfying a Joint Commission surveyor is not a good enough reason to invest in the DUE process. DUE is deceptively complex and labor intensive for hospital and medical staff alike. A better reason to plunge into DUE is to enable pharmacists to concurrently monitor pharmacotherapy, to intervene on behalf of patients, and to positively affect patients' therapeutic outcomes. Thereby, DUE really fits pharmacy's responsibility for pharmaceutical care.     

Designing drug-usage evaluation to meet Joint Commission requirements

Strategies for influencing prescribing practices utilizing the drug-usage evaluation (DUE) process are described. Our DUE program has evolved into a collaborative program that provides significant pharmacy involvement while maintaining medical staff responsibility, as outlined by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission). A multidisciplinary approach is utilized to identify prescribing problems, develop prescribing criteria, and provide educational initiatives. Pharmacists provide drug therapy monitoring, engage in clinical interventions, and document the outcomes of these interventions. DUE pharmacists report results of these initiatives to the medical staff and quality assessment program. Physician performance compliance is incorporated into the credentialing process. Corrective measures are determined by the Pharmacy and Therapeutics Subcommittee, with subsequent actions carried out by peer physicians. The net result is a positive influence on prescribing practices that improves the appropriate and effective use of drugs, while meeting Joint Commission standards.     

应用药物利用评估软件开展药学服务

目的：为了在中国医院开展临床药学工作．提高医院对病人的服务水平。方法：以药物利用评估程序作为开展临床药学的工具．介绍了吉林高新博华医院选择使用头孢曲松钠的10名病人为例，开展药物利用评估程序的过程。结果：通过实施药物利用评估程序，可以发现医院工作中好的方面：(1)10名病人在使用药物前均测定了白细胞总数；(2)病人在使用抗生素时都遵循抗生素使用原则。不理想的方面：(1)仅有2名病人测量了体重；(2)儿童的剂量没有根据体重计算；(3)仅一名病人在使用头孢曲松钠之前使用过其他抗生素。针对上述问题提出具体的改进措施。结论：药物利用评估程序可以给医疗、护理、药局以及医院的管理者和社会提供有用的药物使用信息。随着人们对药学服务质量要求的提高。药物利用评估程序将变得越来越重要．最终被社会和病人所接受。     

A departmental model for drug-usage evaluation

Using the departmental approach, the DUE process has been streamlined to involve one pharmacy discipline (e.g., etomidate, adult surgery), two or more disciplines (e.g., gamma globulin, adult medicine and pediatrics), or all disciplines (e.g., parenteral ranitidine evaluation) based on the extent of the drug-usage problem. The following advantages have been realized as a result of the departmental approach to DUE: the ability for all staff pharmacists to have input in the direction of the DUE program. At the Clinical Pharmacy Committee meetings, all pharmacists are given the opportunity to recommend drugs for usage evaluation. When a number of drug-usage problems are identified, DUEs are prioritized based on the workload of the pharmacists and the scope of the potential drug-use problem. the provision of service-specific evaluations of drug therapy. In addition to meeting the Joint Commission's regulations for DUE, these evaluations allow for each service to examine its individual compliance with the established standards. Service-specific action plans can then be developed to correct any deviations from acceptable practice. the ability to focus the evaluation on those patient populations primarily affected by the potential drug-use problem. the ability to maintain a systematic, ongoing DUE program while maintaining a service-specific approach to pharmacy practice. The satellite pharmacists have developed specialty or division-specific practices in pediatrics, adult medicine, or surgery. Using the matrix approach, pharmacists can contribute to DUE while maintaining a specialty practice.     

Collaborating with physicians in the drug-usage evaluation process

The Joint Commission requires that DUE be performed by the medical staff with pharmacy department participation. To gain physician acceptance of the DUE process, it must be promoted as a means of ensuring quality care and improved patient outcomes, employing an educational rather than punitive approach. Peer interaction is the ideal method to enforce and reenforce desired practices. The pharmacy department can play a major role in ensuring appropriate prescribing practices by reporting information, serving as an educational resource, facilitating physician participation, and overseeing the DUE process.     

An adverse drug reaction reporting system as an integral part of a drug-usage evaluation program

The Adverse Drug Reaction program at CSMC identifies patients whose charts have been encoded with an ICD-9 code of E930 through E949, inclusively. Incidences per drug or drug category have permitted the Department of Pharmacy, acting through the Pharmacy and Therapeutics Committee, to review patient charts, identify trends and risk factors, and subsequently develop usage criteria for DUE studies. It is hoped that these activities will result in an improvement in usage of these drugs and a reduction in adverse drug reactions to them.     

Using label-free screening technology to improve efficiency in drug discovery

INTRODUCTION: Screening assays have traditionally utilized reporter labels to quantify biological responses relevant to the disease state of interest. However, there are limitations associated with the use of labels that may be overcome with temporal measurements possible with label-free. AREAS COVERED: This review comprises general and system-specific information from literature searches using PubMed, published books and the authors' personal experience. This review highlights the label-free approaches in the context of various applications. The authors also note technical issues relevant to the development of label-free assays and their application to HTS. EXPERT OPINION: The limitations associated with the use of transfected cell lines and the use of label-based assays are gradually being realized. As such, greater emphasis is being placed on label-free biophysical techniques using native cell lines. The introduction of 96- and 384-well plate label-free systems is helping to broker a wider acceptance of these approaches in high-throughput screening. However, potential users of the technologies remain skeptical, primarily because the physical basis of the signals generated, and their contextual relevance to cell biology and signal transduction, has not been fully elucidated. Until this is done, these new technology platforms are more likely to complement, rather than replace, traditional screening platforms.     

Integration of drug-usage evaluation with a quality assurance program

"If it ain't broke, don't fix it" is a classic quote that is still heard. Although health professionals strive for continuous improvement in the understanding, prevention, and treatment of pathology, they commonly ignore the system for health care delivery. DUE provides an effective mechanism for continuous examination of the system and improvement of patient outcome as it relates to drug therapy. The movement toward integration of DUE and clinical profiles will bring the Medical Center closer to realizing the ultimate goal of total quality care.     

建立规范化药历,促进临床合理用药

目的：探讨药历的基本概念、基本内容、基本类型、适用范围、临床意义及规范化药历的建立。方法：在开展临床药学服务实践中，借鉴国内外建立药历的经验，探索并建立规范化药历。结果：初步建立了较为实用的、规范化的，并具有自身特色的药历。结论：建立规范化药历可促进临床合理用药，临床药师深入研究规范化药历的建立及其推广具有重要的意义。     

Salt formation to improve drug solubility

Salt formation is the most common and effective method of increasing solubility and dissolution rates of acidic and basic drugs. In this article, physicochemical principles of salt solubility are presented, with special reference to the influence of pH-solubility profiles of acidic and basic drugs on salt formation and dissolution. Non-ideality of salt solubility due to self-association in solution is also discussed. Whether certain acidic or basic drugs would form salts and, if salts are formed, how easily they would dissociate back into their free acid or base forms depend on interrelationships of several factors, such as S0 (intrinsic solubility), pH, pKa, Ksp (solubility product) and pHmax (pH of maximum solubility). The interrelationships of these factors are elaborated and their influence on salt screening and the selection of optimal salt forms for development are discussed. Factors influencing salt dissolution under various pH conditions, and especially in reactive media and in presence of excess common ions, are discussed, with practical reference to the development of solid dosage forms.     

药师依托静脉药物配置中心促进合理用药及其新思路

静脉药物配置中心(PIVAS)已成为医院开展以合理用药为核心的药学服务的重要内容.通过药师在PIVAS的工作,能有效降低临床不合理处方的比例,减少患者因不合理用药而产生的不良反应.但目前药师在PIVAS平台上尚未发挥其全部潜能,审方内容全面化、药师深入临床及加强与医护人员的互动,将有助于全面提升医院合理用药水平.     

Strategies to improve oral drug bioavailability

Efforts to improve oral drug bioavailability have grown in parallel with the pharmaceutical industry. As the number and chemical diversity of drugs has increased, new strategies have been required to develop orally active therapeutics. The past two decades have been characterised by an increased understanding of the causes of low bioavailability and a great deal of innovation in oral drug delivery technologies, marked by an unprecedented growth of the drug delivery industry. The advent of biotechnology and consequent proliferation of biopharmaceuticals have brought new challenges to the drug delivery field. In spite of the difficulties associated with developing oral forms of this type of therapeutics, significant progress has been made in the past few years, with some oral proteins, peptides and other macromolecules currently advancing through clinical trials. This article reviews the approaches that have been successfully applied to improve oral drug bioavailability, primarily, prodrug strategies, lead optimisation through medicinal chemistry and formulation design. Specific strategies to improve the oral bioavailability of biopharmaceuticals are also discussed.     

Strategies to improve oral drug bioavailability

Efforts to improve oral drug bioavailability have grown in parallel with the pharmaceutical industry. As the number and chemical diversity of drugs has increased, new strategies have been required to develop orally active therapeutics. The past two decades have been characterised by an increased understanding of the causes of low bioavailability and a great deal of innovation in oral drug delivery technologies, marked by an unprecedented growth of the drug delivery industry. The advent of biotechnology and consequent proliferation of biopharmaceuticals have brought new challenges to the drug delivery field. In spite of the difficulties associated with developing oral forms of this type of therapeutics, significant progress has been made in the past few years, with some oral proteins, peptides and other macromolecules currently advancing through clinical trials. This article reviews the approaches that have been successfully applied to improve oral drug bioavailability, primarily, prodrug strategies, lead optimisation through medicinal chemistry and formulation design. Specific strategies to improve the oral bioavailability of biopharmaceuticals are also discussed.     

Outcome evaluation of an intervention to improve the effective and safe use of meropenem

Background Pharmacists have been involved in promoting the proper and safe use of antimicrobial drugs in our institution since 2010. Setting Kochi Medical School Hospital, Japan. Objective To design and evaluate a plan of administration of meropenem (MEPM) based on its pharmacokinetics and pharmacodynamics, drug sensitivity, bacterial cultures, patient condition and renal function. Method A total of 547 patients admitted between April 2010 and March 2013 with serious infections who were successfully treated with MEPM for three or more days were analysed. Patients were initially divided into two groups according to renal function: group A consisted of patients with mild renal dysfunction [creatinine clearance (CLcr) > 50 mL/min] while group B consisted of patients with moderate to severe renal dysfunction (CLcr ≤ 50 mL/min). These groups were then subdivided into two groups according to the implementation of pharmacist intervention. Main outcome measures Daily dose, frequency of administration, dose interval, duration of therapy, adverse events and cost reduction. Results In the non-intervention subgroup within group A, the daily dose was 1,000 mg/day, the frequency of administration was 1.8 ± 0.6 times/day, and the duration of therapy was 9.4 ± 5.4 days. In the intervention subgroup within group A, the daily dose was 1,500 mg/day, the administration frequency was 2.5 ± 0.6 times/day, and the duration of therapy was 7.4 ± 3.7 days. Although the dose was higher (P < 0.05) and the duration of therapy was an average of 2 days shorter (P < 0.05) in the intervention subgroup, there was no significant difference in the rate of adverse events between the two subgroups. In group B, there were no significant differences between the two subgroups in the daily dose, administration frequency, or duration of therapy. However, liver dysfunction was significantly more common in the non-intervention subgroup than in the intervention subgroup (P < 0.05). The total reduction in drug cost in the intervention groups was estimated to be US$17,490 over 3 years. Conclusion Pharmacist intervention was associated with a shorter duration of therapy, lower drug costs, and decreased adverse effect. We believe that our intervention is beneficial in terms of effectiveness and safety, and supports proper antimicrobial use.