Transcript Pharmaceutical Outcomes and Drug Use Evaluations

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
ACT
PLAN
CHECK
DO
DUE CYCLE
COLLECT
DATA
ACTION
FEEDBACK
FEEDBACK
EVALUATED
DATA
EVALUATE
DATA
CHECK =
AUDIT=
COLLECT DATA AND EVALUATE
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
Judicious
Appropriate
Safe
effective
acceptable to patient
(BARBER)
 daily commitment of the pharmacist so what is different
 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
Why have DUE?
 Clinical benefits
 Evidence based medicine
 Educational benefits
 Economic benefits
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
Evidence Based medicine
Clinical Expertise
Patient
Values
Decision
Best research evidence
Evidence Based Medicine
FIVE STEPS
 Answerable question
 best current evidence
 validity, impact, applicability
 integrate with clinical expertise
 evaluate performance
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
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
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
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)
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
DUE CYCLE
COLLECT
DATA
ACTION
FEEDBACK
FEEDBACK
EVALUATED
DATA
EVALUATE
DATA
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
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. .
 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
INVOLVEMENT IN A NATIONAL
MULTICENTRE DUE –
An evaluation by APOP participating Queensland hospitals
Donna R Taylor, Lisa K Pulver, Susan E Tett, Judith A Coombes.
School of Pharmacy
University of Queensland
Background:
Results:
Key messages:
14 hospitals participated in the Queensland arm of
the national NPS-funded Acute Postoperative Pain
project (APOP).
Response rate of 100%,

Previous project participation informs accuracy of estimate of
resource allocation
Previous participation in a QI project*
Aware of time commitment *
(*Strong correlation)

Team approach most effective, least draining
Participants were invited to a state project wrap-up
meeting to facilitate project de-briefing.

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
comprised equally of Pharmacy and Nursing
Time frame ‘about right’
100
Aim:
-
36%
36%
-
58%
PERCEIVED LEVEL of SUPPORT
90
80
To evaluate the experience of participants in a
national multi-centre DUE.
70
60
%
50
Conclusion:
40
Method:
Participating hospitals were requested to complete a
project evaluation questionnaire prior to the meeting,
for presentation on the day.
Project evaluation by the participants provided valuable project
de-briefing and useful management information for future national
multicentre projects.
30
20
10
0
Assistance
provided
Expected in
normal hours
Sufficient
hospital
support
Sufficient
information
provided
Support from
QLD
coordinator
The experience from all hospitals was very positive, and is
encouraging for future participation in planned national multi-site
DUEs.
Acknowledgements:
Materials
NPS Feedback useful/very useful
NPS Feedback used to
inform Academic Detailing
A customise
positivePower
impact
at the hospital Point presentation
• Quality
wrt specific
project
aims
of material - good or excellent
(pain
documentation, education, prescribing)Used
manual
• Used
on the
hospital dynamic
website
(collaboration/communication/teamwork)
A positive impact on the participant
The Queensland Team
•
•
•
•
Increased confidence
Increased project and people management skills
Satisfaction in effecting behaviour change
Satisfaction in collaboration
85%
-
100%
100%
92%
~50%
100%
86%
~50%
71%
-
100%
-
Our grateful thanks for the development of the evaluation tool to
the state-based DUE group in Victoria, and for the support
provided 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.
DUE CYCLE
COLLECT
DATA
ACTION
FEEDBACK
FEEDBACK
EVALUATED
DATA
EVALUATE
DATA
DUE Studies
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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
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
Conclusion
 DUE is for everyone
 DUE is not research in its purest form BUT
 DUE is a way of changing practice