The document outlines the history and evolution of drug use evaluation (DUE) and drug utilization review (DUR) in healthcare, emphasizing the importance of evaluating medication use to enhance patient safety and outcomes. It discusses methodologies for assessing drug utilization, including performance improvement methods and various analyses to monitor prescribing patterns and safety issues. The role of pharmacists in medication use evaluation processes is highlighted, along with strategies for ensuring rational drug use and addressing issues like polypharmacy.

1. Drug Use Evaluation (DUE) /
Drug Use Review (DUR)
DR. HAMID SAEED
Assistant Professor of Clinical Pharmacy
University College of Pharmacy
University of the Punjab

2. Acronyms Associated with the evaluation
of medication use
Drug use review (DUR)
• 1969 on prescription drugs
• Retrospective evaluation to monitor medication use
patterns (trends) ,quantitative
Antibiotic use Review (AUR):
• 1978
• Retrospective evaluation of antibiotic use
• quantitative
• Limited to identifying pattern of use

3. Acronyms Associated with the evaluation
of medication use
Drug use Evaluation (DUE) :
– 1986 Multidisciplinary involvement
– Expansion of AUR to all drugs
– evaluation of prescribing and outcome only.
Medication use evaluation (MUE):
– 1992
– Expansion of DUE to include all medications
– Evaluation expanded to include all aspects of
medication use: Prescribing, dispensing,
administration, monitoring etc.

4. Definition
• MUE is a performance improvement method
that focuses on evaluating and improving
medication – use processes with the goal of
optimal patient outcomes
• OR
• Drug utilization review (DUR) is defined as an
authorized, structured, ongoing review of
prescribing, dispensing and use of
medication
Am J Hosp Pharm. 1996;53:1953-5

5. • MUE may be applied to a medication or therapeutic
class, dis- ease state or condition, a medication-use
process (prescribing, preparing and dispensing,
administering, and monitoring), or specific outcomes.
• Potential tool in the evaluation of health care system
• With main objective to ascertain drug use in society
• Casual observation, as well as more systematic study
of prescribing practices, frequently reveals a pattern of
diversity among prescribers in the treatment of even
the most common conditions.

6. • Specific Population
• Elderly – incorrect use of medication and poly-
pharmacy
• Children – poor development of functions and
most of the drugs are intended for adults.
• Improved Outcomes
• Potential hazards
• Un-necessary finances
• Thus, its is necessary to have a periodic review of
the pattern of drug utilization to ensure safe and
effective treatment.

7. Purpose
• The purpose of DUR is to ensure drugs
are used appropriately, safely and
• effectively to improve patient health
status

8. Why DUE is becoming more
important..?
• The boost in the marketing of new drugs,
• Wide variations in the pattern of drug prescribing and
consumption
• Growing concern about the delayed adverse effects,
• Increasing concerns regarding the cost of drugs and
• Volume of prescription
• All contribute to the increasing importance of DUE

9. Criteria
• Predetermined criteria for appropriate
• drug therapy are compared against a patient’s
or a population’s records.
• Non-adherence to criteria results in drug
therapy changes.
• In addition, continual improvement in the
appropriate, safe and effective use of drugs has
the potential to lower the overall cost of care
• DUR allows the pharmacist to document and
evaluate the benefit of pharmacy intervention in
improving therapeutic and economic outcomes
while demonstrating the overall value of the
pharmacist

10. • prospective DUR often relies on
computerized algorithms to perform key
checks including drug interactions,
duplications or contraindications with
the patient’s disease state or condition

11. Issues Requiring DUE
• Poly-pharmacy is one problem; providers may use three, four, five, and
sometimes more medicines to treat the most trivial conditions for the sake of
satisfying a patient’s need to receive medicines (or the pharmaceutical seller’s
need for profit).
• Other reasons for poly-pharmacy include lack of diagnostic competence or
confidence and an inadequate knowledge of treatment regimens.
• Other common medicine use problems are choosing incorrect medicines,
prescribing the incorrect dose, prescribing medicines that cause adverse drug
reactions (ADRs) or medicine interactions, and using more expensive medicines
when less expensive medicines would be equally or more effective.

12. General Aim
• A system of improving the quality of medicine use in
hospitals and clinics, is an ongoing, systematic,
criteria-based program of medicine evaluations that
will help ensure that appropriate use of medicine.
• A DUE can be structured so that it will assess the
actual process of administering or dispensing a
medicine (i.e., appropriate indications, dose,
medicine interactions) or assess the outcomes (i.e.,
cured infections, decreased lipid levels.)

13. Objectives
• Promoting optimal medication therapy.
• Preventing medication-related problems.
• Evaluating the effectiveness of medication therapy.
• Improving patient safety.
• Establishing interdisciplinary consensus on medication-use
processes.
• Stimulate improvements in medication-use processes.
• Ensure standardization in medication-use processes.
• Enhancing opportunities, through standardization, to assess the
value of innovative medication-use practices from both patient-
outcome and resource-utilization perspectives.
• Minimizing procedural variations that contribute to suboptimal
outcomes of medication use.

14. • Identifying areas in which further information and education
for health care professionals may be needed
• Minimizing costs of medication therapy. These costs may be
only partly related to the direct cost of medications
themselves.
• When medications are selected and managed optimally from
the outset, the costs of complications and wasted resources
are minimized, and overall costs are decreased.
• Meeting or exceeding internal and external quality standards
(e.g., professional practice standards, accreditation
standards, or government laws and regulations)
• Enhancing accountability in the medicine use process

15. Scope of Drug Use Evaluation
• Drug use evaluation (DUE) aims to understand how and why
drugs are used so as to improve appropriate drug use and
the health outcome (Sathvik, 2004).
• DUE can be aimed to analyze the present and the
developmental trends of drug usage at various levels of the
health care system, whether national, local or institutional.
• DUE may evaluate drug use at a population level, based on
the demographic details (Gama, 2008).
• These studies are used to calculate the reported adverse
drug reactions, to monitor the utilization of various categories
of drugs, to monitor the regulatory activities.

16. • Drug utilization data may be used to produce crude estimates of
disease prevalence, such as cardiovascular disease (Psaty et al.,
2006), diabetes (Duarte-Ramos and Cabrita, 2006).
• Drug utilization data may be also used to plan drug importation,
production, and distribution, and to estimate drug expenditures.
• They can document the extent of inappropriate prescribing of
drugs activities (Gama, 2008).
• DUE helps the healthcare system to understand, interpret and
improve prescription, administration and use of medications
(Sathvik, 2004).
• DUS are particularly interesting if focused on the most frequently
used and misused groups of therapeutic drugs, such as antibiotics,
chemotherapeutic agents, or those that constitute important
therapeutic innovations (Krivoy et al., 2007).

17. Why Drug Utilization Research is
Necessary..?
• The aim is to facilitate the rational use of drugs in
populations.
• In individual patients, the rational drug use implies the
prescription of a well-documented drug in an optimal
dose on right indication at an affordable price.
• It is important to realize that inappropriate use of drugs
represent a potential hazard to the patients and an
unnecessary expense (Hawkey et al., 1990).
• It is difficult to understand the rational use of drug
without the knowledge on how drugs are being
prescribed.

18. • DUE contributes to
• rational drug use by describing the drug use pattern and
interventions.
• Helps in understanding how drugs are being used by making
estimates of number of patients exposed to drugs, describing and
estimating to what extent the drugs are used at certain area,
whether overused or underused,
• It compares the observed patterns of drug use with current
recommendations or guidelines.
• Feed back is provided to the prescribers based on the drug
utilization data collected.
• Drug utilization research enables to assess whether interventions
undertaken improves the drug use by monitoring and evaluating
patterns of drug use (Sjoqvist and Brikett, 2003).

19. Types of Drug Use Information
• Drug based information
• Detailed information is usually required to answer
clinically important questions which may involve
aggregation of drug use at various levels, and
information on indications, doses and dosage
regimens.
• Problem based information
• The question must be addressed to know more about
the problem that is being managed instead of knowing
about the particular group of drugs used for any
condition.

20. • Patient information
• Demographics and other information will be useful for the studies.
• The age distribution has critical importance in some cases e.g., to
know whether the drug is being used in an age group different from
that in which clinical trials were performed.
• The co-morbidities of the patient group may be important in
determining treatment choice and adverse effects.
• For example in the management of hypertension in asthma patients,
beta blockers should be avoided.
• Prescriber information
• The differences in the drug prescribing often lack rational explanations.
• This type of information helps to determine the prescribing behavior
which is often helpful to understand how and why drugs are
prescribed.

21. Role of Pharmacist in DUE
• Pharmacists, by virtue of their expertise and their
mission of ensuring proper medication use, should
exert leadership role and work collaboratively with
other members of the health care team in the
ongoing process of medication-use evaluation and
improvement.
• Responsibilities of pharmacists in the MUE process
include;

22. • Pharmacist’s Responsibilities
• Developing an operational plan for MUE programs and
processes that are consistent with the health system’s
overall goals and resource capabilities.
• Working collaboratively with prescribers and others to
develop criteria for specific medications and to design
effective medication-use processes.
• Reviewing individual medication orders against
medication-use criteria and consulting with prescribers
and others in the process as needed.

23. • Managing MUE programs and processes.
• Collecting, analyzing, and evaluating patient-
specific data to identify, resolve, and prevent
medication-related problems.
• Interpreting and reporting MUE findings and
recommend changes in medication-use processes.
• Providing information and education based on MUE
findings.

24. A Step Wise Approach to DUE
• 1. Establish Responsibility
– Drug therapeutic committee (DTC) monitor DUEs in
hospital and clinics
– The DTC must establish procedures that will govern the
committee in its activities concerning medicine use
review and evaluation.
– DTC must establish a plan, outlining which medicines
will be a part of the DUE process.
– This plan needs to be updated and evaluated each year.

25. Develop Scope of Activities
• 2. The scope can be extensive or it can focus on a
single aspect of pharmaceutical therapy.
– Methods to identify medicine use problems include; ABC
or vital, essential, nonessential (VEN) analysis, defined
daily dose analysis, ADR reports, medication error
reports, antibiotic sensitivity results, procurement
studies, hospital and primary care clinic indicator
studies, patient complaints or feedback, and staff
feedback.

26. • DTC must concentrate on the most important medicines, those
with the highest potential for problems, to get the most return on
the work involved.
• These high priority areas would include
• High-volume medicine use
• Medicines with a low therapeutic index
• Medicines with a high incidence of ADRs
• Expensive medicines

27. ABC analysis
Most pharmacists and managers know that only a few drug items account for the greatest
drug expenditure.
Often 70-80% of the budget is spent on 10-20% of the medicines.
ABC analysis is the analysis of annual medicine consumption and cost in order to determine
which items account for the greatest proportion of the budget.
It can reveal:
• High usage items for which there are lower-cost alternatives on the list or
available in the market.
This information can be used to:
- choose more cost-effective alternative medicines
- identify opportunities for therapeutic substitution
- negotiate lower prices with suppliers.

28. • A-items: 20% of all goods contribute to 70-80% of the
annual consumption value of the items
• B-items: 30% of all goods contribute to 15-25% of the
annual consumption value of the items
• C-items: 50% of all goods contribute only 5% of the
annual consumption value of the items
• In order to calculate the annual consumption value of
any item or items:
• Annual consumption value = annual demand x item
cost per unit

29. • Measure the degree to which actual drug consumption
reflects public health needs and so identify irrational drug
use, through comparing drug consumption to morbidity
patterns.
• Identify purchases for items not on the hospital essential
medicines list i.e. the use of non-formulary medicines.

30. ABC Analysis example -
Calculations and Ranking
PRODUCT
DESCRIPTION
Basic
unit
Unit price
US$
Total units Value
(US$)
% Total
value
Rank by
value
Cumulati
ve
Cate
gory
Benzylpenicillin
1MU inj
amp 0.5276 144,000.00 75,974.40 25.66% 1 25.7% A
Chloroxylenol
5% solution
ml 0.0034 10,728,00.0 36,475.20 12.32% 2 38.0% A
Ampicillin
125mg/5ml
powder for susp,
100ml
bot 0.5119 43,970.00 22,508.24 7.60% 4 55.8% A
Erythromycin
250mg tab
tab 0.0350 262,000.00 9,170.00 3.10% 7 68.4% B
Cotrimoxazole
400mg/80mg
tab
tab 0.0098 860,000.00 8,428.00 2.85% n 71.3% B

31. VEN analysis is a well-known method to help set up priorities for purchasing
medicines and keeping stock.
Drugs are divided, according to their health impact, into vital, essential and non-essential
categories.
VEN analysis allows medicines of differing efficacy and usefulness to be compared, unlike
ABC and therapeutic category analyses, where only drugs of similar efficacy or action can
be compared.
• vital drugs (V): potentially life-saving or crucial to providing basic health services
• essential drugs (E): effective against less severe but significant forms of disease, but not
absolutely vital to providing basic health care
• non-essential drugs (N): used for minor or self-limited illnesses; these may or
may not be formulary items and efficacious, but they are the least important items stocked.

32. VITAL ESSENTIAL NON-ESSENTIAL
(1) Potentially life-
saving
(2) Significant
withdrawal side-
effects
(3) Major public health
importance
Effective against less
severe but significant
forms of illness
(1) Used for minor or self
limited illnesses
(2) Questionable efficacy
(3) High cost for marginal
therapeutic advantage
SUMMARY OF STEPS OF VEN ANALYSIS
Each DTC member should classify all the medicines as V, E, or N
The results of each member’s classification should be compiled and an
overall classification agreed in the DTC

33. The DTC should then:
identify and limit therapeutic duplication examine all the N items and where
possible decrease the quantities purchased or eliminate them
reconsider proposed purchase quantities, buying V and E items before N items
and ensuring that safety stocks are higher for V and E items
monitor drug ordering and stock levels for V and E items more closely than for
N items.

34. Characteristics of the drug and target
condition
Vital Essential Non-
essential
Occurrence of target condition
% of population affected >5% 1-5% <1%
Average number of patients treated per day in
an average facility
>5 1-5 <1
Severity of target condition
Life-threatening Yes Occasionally Rarely
Disabling Yes Occasionally Rarely
Guidelines

35. Characteristics of the drug and
target condition
Vital Essential Non-
essential
Therapeutic effect of drug
Prevents serious disease Yes No No
Cures serious disease Yes Yes No
Treats minor, self-limited symptoms
and conditions
No Possibly Yes
Has proven efficacy Always Usually Maybe
Does not have proven efficacy Never Rarely Maybe

36. Define Daily Dose (DDD)
• The analysis of medicine consumption in terms of unit quantities
can help to identify over- and under-use of individual medications
or therapeutic groups.
• The defined daily dose (DDD) methodology converts and
standardizes readily available product quantity data, such as
packages, tablets, injection vials, bottles, into crude estimates of
clinical exposure to medicines, such as the number of daily doses.
• The DDD is the assumed average daily maintenance dose for the
medication’s main indication.

37. • It is defined globally for each medicine by the WHO Collaborating Centre
for Drug Statistics in Oslo, Norway, (http://www.whocc.no; see annex 6.1
for addresses and the DDDs for some medicines).
• The DDD is based on the average maintenance dose for adults, but it
can be adjusted for paediatric medicine use.
Converting aggregate quantities available from pharmacy inventory records
or sales statistics into DDDs roughly indicates how many potential treatment
days of a medicine have been procured, distributed or consumed.
The medicines can then be compared, using units such as:
• no. of DDD per 1000 inhabitants per day, for total drug consumption
• no. of DDD per 100 beds per day (100 bed-days), for hospital use

38. • if the calculations for amoxicillin show that there were 4 DDDs per 1000
inhabitants per day, this suggests that on any given day, for every 1000
persons, 4 adults received a daily dose of 1 g of amoxicillin.
• If calculations of gentamicin use are expressed as 2 DDD per 100 bed-
days, this tells us that, for every 100 beds in the hospital, every day 2
patients received 240 mg of gentamicin.
• The assigned DDD for amoxicillin is 1 g and for gentamicin is 240 mg.
• These interpretations assume that the prescribed daily dose (the
quantity actually prescribed to a patient) is the same as the defined daily
dose, although this may not, in fact, be the case.

39. Important Points
• • DDDs provide a unit of measurement that is independent of price
and formulation, making it possible to assess trends in consumption
of medicines and to perform comparisons between population
groups and health-care systems.
• • DDDs have not been established for topical medicines, vaccines,
general/local anesthetics, contrast media and allergen extracts.
• • The DDD method should only be used in settings where reliable
procurement, inventory or sales data have been recorded.

40. How to Calculate
Steps Example
1 Find out the total amount of medicines
used or procured in one year in terms of
the number of units (tablets, capsules,
injections) and the strength (mg, g (gm),
IU)
Yearly amounts of methyldopa used by a provincial
hospital and surrounding clinics, covering a
population of 2 million:
25 000 tablets of methyldopa 250 mg, and3 000
tablets of methyldopa 500 mg
2 Calculate the total quantity consumed
in one year in terms of mg/g/I.U. by
multiplying the number of units (tabs,
caps, inj.) by the strength of dose
Total yearly consumption of methyldopa
= (25 000 x 250 mg) + (3000 x 500 mg)
= 7 750 000 mg (7750 g)
3 Divide the total quantity by the
assigned DDD for that medicine
Methyldopa assigned DDD = 1 g
Thus, no. of DDDs of methyldopa consumed
= 7750 g/1 g = 7750 DDD
4 Divide the total quantity by the number
of patients(if known) or by the population
(as shown)
Annual consumption of methyldopa
= 7750 DDD per 2 000 000 inhabitants per year
= 3.875 DDD per 1000 inhabitants per year

42. Important Categories
• Medicines that are critically important
categories; cardiovascular, emergency,
toxicology, oncology, intravenous medicines,
and narcotic analgesics
• Antimicrobial medicines, both prophylactic
and therapeutic Injections
• Medicines undergoing evaluation for addition
to the formulary
• Medicines used for off-label indications
• Medicines used for high-risk patients

43. Establish Criteria, Define and
Establish Threshold
• Establishing criteria is the single most
important procedure in a DUE.
• Criteria for the use of any medicine should be
established by the DTC using relevant
evidence-based literature sources and
recognized international and local experts.
• The criteria for any DUE should reflect what
is in the country’s STGs (assuming that they
have been developed correctly) and any
medicine-use protocols that exist.

44. • Credibility of the DUE relies on criteria that are
based on evidence-based medicine. Criteria must
be developed with and accepted by the medical
staff for the process to be credible
• After developing criteria, the DTC must establish a
threshold or standard (benchmark) against which
the criteria will be judged.
• A threshold refers to the percentage of charts or
records that will meet or exceed the established
criteria for the medicine.

45. • Ideally, this threshold will be 100 percent,
but realistically, a smaller percentage will
be more appropriate to account for
exceptions to routine medicine prescribing.
• Therefore, a threshold of 90 to 95 percent
is typically used for many criteria, but each
instance must be carefully analyzed before
reaching a conclusion.

46. • A comprehensive list of indicators for
appropriate medicine use includes the
following components
• Process indicators
• o Indications—specific uses for the medicine
in question
• o Dose—specific doses for any approved
indication for appropriate duration
• o Quantity dispensed—correct number of
doses administered

47. • o Preparation—steps involved with preparing a
medication for administration
• o Monitoring—laboratory test necessary and
intervals of testing during the use of the medicine
• Contraindications—known contraindications
o Drug interactions—significant medicine
interactions, including medicine-medicine,
• medicine-food, and medicine-laboratory
• o Administration—specific steps necessary to
administer a medicine, especially for injectables

48. • o Patient education—instructions and
education that a patient should receive with
the medicine
• • Outcome indicators—specific outcomes to
be realized from medicine use
• Lowered blood pressure, stabilized blood
glucose, and fewer migraine and asthma
• attacks
• Decreased visits to the emergency room,
decreased hospitalizations

49. • Improved patient quality of life (obtained from
questionnaires) •
• Pharmacy administration indicators
• Correct cost to patient
• Accurate billing records
• Accurate dispensing records
• Appropriate use of generic medicines or
therapeutic equivalents
• Appropriate use of formulary medicines
• Appropriate quantity dispensed

50. Collect Data and Organize Results
• DUEs can be accomplished as prospective
evaluations, or they can be performed retrospectively.
• A prospective analysis involves the collection of data
as the medicine is being prepared or dispensed to the
patient.
• Retrospective analysis is done using chart reviews or
other data sources to review medicine use according
to indicators and criteria prepared in advance.
• The advantage of a prospective review is that the
pharmacist (or other reviewer) can intervene at the
time the medicine is dispensed to prevent errors in, for
example, dosage, indications, or interactions.

51. • Retrospective evaluation, which may
involve more of the reviewer’s time or
require access to medical records, is best
accomplished when the reviewer has time
away from the patient care areas and
distractions.

52. DUE Categories
• Prospective DUE
• Prospective review involves evaluating a
patient's planned drug therapy before a
medication is dispensed.
• In this process the pharmacist can identify
and resolve problems before the patient
receives the medication. Pharmacists
routinely perform prospective reviews by
assessing a prescription medication's dosage
and its directions and

53. • reviewing patient information for possible drug
interactions or duplicate therapy (APhA, 1995).
• A prospective study watches for outcomes, such as
the development of a disease, during the study period
and relates this to other factors such as suspected risk
or protection factor(s).
• Prospective DUE commonly addresses
• drug-disease contraindications,
• therapeutic interchange,
• generic substitution,
• incorrect drug dosage,
• inappropriate duration of drug treatment,
• drug-allergy interactions and clinical abuse/misuse.

54. • All efforts should be made to avoid
sources of bias such as the loss of
individuals to follow up during the study.
• Prospective studies usually have fewer
potential sources of bias and confounding
than retrospective studies

55. • Concurrent DUE
• Concurrent review is performed during the
course of treatment and involves the ongoing
monitoring of drug therapy to ensure positive
patient outcomes.
• It presents pharmacists with the opportunity
to alert prescribers to potential problems and
to intervene in areas such as drug- drug
interactions, duplicate therapy, and excessive
or insufficient dosing.

56. • This type of review allows therapy to be
altered for a patient if necessary (APhA,
1995).
• Concurrent DUE commonly addresses drug-
drug interactions, excessive doses, high or
low dosages, duplicate therapy, drug-disease
interactions, over and under utilization, drug-
age precautions, drug-gender precautions,
and drug-pregnancy precautions.

57. • Retrospective DUE
• A retrospective DUE is the simplest to
perform since drug therapy is reviewed after
the patient has received the medication.
• A retrospective review may detect patterns in
prescribing, dispensing, or administering
drugs to prevent recurrence of inappropriate
use or abuse and serves as a means for
developing prospective standards and target
interventions.

58. • In retrospective DUE, patient medical
charts or computerized records are
screened to determine whether the drug
therapy met approved criteria and aids
prescribers in improving care for their
patients, individually and within groups of
patients, such as those with diabetes,
asthma, or high blood pressure (APhA,
1995).

59. • Retrospective DUE commonly addresses the
issues such as
• Therapeutic appropriateness,
• Over and under utilization,
• Appropriate generic use,
• Therapeutic duplication,
• Drug-disease contraindications,
• Drug-drug interactions,
• Incorrect drug dosage,
• Inappropriate duration of treatment,
• Clinical abuse/misuse.

60. Analyze Data
• Data are collected, tabulated, and analyzed to see
if criteria and thresholds are met. The following
important steps should be completed when
analyzing data—
• Tabulate results for each indicator
• Analyze results to see if the criteria are met and
the thresholds are not exceeded
• Determine why thresholds are not met
• Analyze data quarterly or more frequently
• If a threshold is not met, it may indicate a medicine
use problem that requires the attention of the
DTC.

61. Develop Recommendations and
Action plan
• After completing the data analysis,
information is presented to the DTC and a
decision is made as to the appropriateness of
the information in the DUE.
• The DTC also must decide on whether to
continue, discontinue, or expand the
functions of the DUE in question.
• All medicines that do not meet the thresholds
must be evaluated carefully and plans must
be made to improve the use of the medicine
relative to the criteria.

62. • Recommendations should be prepared for
the DTC to address the following—
– Inappropriate medicine use
– Unacceptable patient outcomes
– Methods to resolve any medicine use problem

63. • Interventions to improve medicine use
might include—
– Education, including letters to practitioners, in-
service education, workshops, newsletters,
and face-to-face discussions
– Implementation of medicine order forms
– Prescribing restrictions
– Formulary manual changes
– Change (or better enforcement) of the STGs

64. Conduct DUE Follow Up
• Follow-up in every DUE is critical to ensure
resolution of any unresolved medicine use
problems.
• If the problems are not resolved, then the
DUE will have little usefulness to the health
care system.
• As a part of a follow-up plan, the DTC must
assess the need to continue, modify, or stop
the DUE activity depending on the results of
each specific medicine review.

65. • All programs within the DTC should be evaluated
yearly.
• This complete evaluation is necessary to look
comprehensively at the entire program and
analyze its merits and its utility in improving
medicine use.
• Programs that do not have a significant impact on
medicine use should be redesigned so that they
can provide measurable improvements.
• Without improvements in medicine use and patient
outcomes, the time spent on DUE will be of no
value.

66. When DUEs go Wrong
• Lack of authority and organization—The
DUE must have a clear organizational
structure defined including, for example,
• what person develops criteria,
• collects data,
• and reports results.
• Clinicians must be involved in the
development.

67. • Poor problem prioritization—Poor
prioritization may lead to work on medicine
use problems that may be insignificant and
make meaningful results difficult to obtain.
• Poor documentation—All activities should be
documented with a report in the DTC
minutes, and this report should be distributed
to the medical staff as necessary;
documentation should clearly discuss results
and recommendations of each DUE.

68. • Inadequate follow-up—This problem is one of
the most frequent to occur with DUE; follow-
up and resolution of every problem must be
accomplished with every DUE.
• Overly intrusive data collection and
evaluation—This process can consume many
individuals’ time and must be kept to a
minimum to accomplish the task of the DUE;
DUEs in general must not take a significant
amount of time away from patient care.

70. Drug Use Evaluation Criteria for Cimetidine

71. Vancomycin
Drug
Utilization
Evaluation
Data
Collection
Form

72. • Assignment
• Drug Use Evaluation Criteria & Data
Collection Form for Steroids -
Prednisolone