Prescriptions for outpatient pharmaceuticals can be reviewed by drug usage review programs to ensure that they are suitable, that they are needed for medical reasons, and that they are not likely to result in negative medical repercussions. For the purpose of assisting in the administration of data regarding the prescribing of medications and the distribution of prescriptions over extended periods of time, DUR programs make use of professional medical procedures, as well as computer technology and data processing.
What is the purpose of Dur?
What does it mean to have a Drug Utilization Review? – The DUR is a regulated and systematic continuing evaluation of pharmaceutical prescribing by practitioners, medication distribution by pharmacists, and patient utilization of drugs. The goal of DUR is to ensure that medications are used in a manner that is appropriate, safe, and effective in order to enhance the health condition of patients.
- The records of a patient or group are checked against predetermined criteria to assess whether or not an appropriate medication therapy was administered;
- Changes to the prescribed medication are necessary when conditions are not met;
In addition, there is the potential for total healthcare costs to be reduced if there is ongoing progress in the appropriate, safe, and effective utilization of medications. 12,13,14 Using DUR, the pharmacist is able to document and analyze the efficacy of pharmacy intervention in terms of increasing clinical and economic outcomes, all while demonstrating the total value that the pharmacist provides.
- In most cases, the 15 DUR is divided into these three distinct categories: prospective, concurrent, and retrospective;
- Prospective DUR: A prospective review is an evaluation of a patient’s planned drug therapy that takes place prior to the dispensing of a prescription;
Because of this procedure, the pharmacist is able to recognize and address any issues that may arise before the patient ever receives the drug. In the course of their normal work, pharmacists are expected to perform prospective reviews on a regular basis.
This involves analyzing the dosage and instructions for a prescribed medication, as well as reviewing patient information to look for potential drug interactions or instances of duplicate therapy. When used as a component of an online claims adjudication process, prospective DUR frequently depends on computerized algorithms to perform key checks.
These checks may include determining whether the patient’s disease state or condition is associated with drug interactions, duplications, or contraindications. Concerns Typically Voiced by Those Considering a DUR Position:
Clinical abuse/misuse disease-drug interactions that should not be employed (when a prescribed drug should not be used with certain diseases) Drug dosage modification Interactions between various medicines (when two or more different drugs interact and alter their intended effects, often causing adverse events) Drug-patient precautions (due to age, allergies, gender, pregnancy, etc.
) Formulary subtraction and addition (e. , therapeutic interchange, generic substitution) Unreasonable amount of time spent for drug treatment
An illustration of this would be the identification of drug-drug interactions, which is a typical consequence of a prospective DUR.
A patient who is being treated with warfarin to avoid blood clots, for instance, may have another physician prescribe a new medicine to treat arthritis to the patient at the same time. If both of these medications were taken at the same time, the patient would have bleeding inside.
Following the examination of the patient’s prescriptions, the pharmacist would become aware of the potential medication interaction and then get in touch with the doctor to make him or her aware of the issue.
Concurrent DUR: Concurrent review is conducted over the course of treatment and entails the continual monitoring of medication therapy in order to support excellent patient outcomes. Concurrent review is referred to as “DUR.” It gives pharmacists the opportunity to alert prescribers to potential problems and intervene in areas such as drug-drug interactions, duplicate therapy, over or underutilization, and excessive or insufficient dosing.
- In addition, it allows pharmacists to intervene in areas such as overdosing or underdosing;
- Alterations to the treatment plan for a patient are possible after this kind of evaluation, should they be required;
The concurrent DUR procedure may be done by the physician at the moment of prescription transmission to the pharmacy if electronic prescribing becomes more generally implemented. This will enable for interventions to be taken before the medicine is actually delivered.
In order to fulfill the requirements of the DUR, the patient’s medication and allergy data need to be up to date and comprehensive, and the clinician has to be aware of the acceptable therapeutic interchanges for each individual.
On the side of administering these medications, pharmacists will play a function analogous to that of prescribers so as to provide an additional layer of protection. Concerns That Are Typically Resolved Using Concurrent DUR:
Interactions between drugs and diseases Interactions between different drugs Drug dosage alterations Drug-patient precautions (age, gender, pregnancy, etc.
- ) Over and underutilization Interactions with a Healing Purpose
A common scenario for the occurrence of concurrent DUR is the provision of different drugs to a single patient in an institutional environment;
When patient data are reviewed on a regular basis, it is possible to identify real or prospective instances of drug-drug interactions as well as duplicate treatments. In addition to this, it can serve as an indicator to the pharmacist of the necessity to switch drugs, such as antibiotics, or to make modifications to dose depending on the findings of laboratory tests.
After that, the key prescriber (or prescribers) need to be made aware of the issue so that appropriate action may be done. DUR, or Duration, in Retrospect: A retrospective DUR is an examination of the patient’s treatment with drugs after the patient has been given the medicine.
In order to identify patterns in the prescribing, dispensing, or administration of medications, a retrospective review is typically performed. On the basis of the existing patterns of medication use, prospective standards and specific interventions can be designed in order to reduce the likelihood of improper medication use or abuse occurring in the future.
- The findings of this research may be of use to prescribers in enhancing the care that they provide for their patients, either on an individual basis or within a specific group (e;
- , patients with diabetes, asthma, or high blood pressure);
Concerns That Are Typically Resolved Using Retrospective DUR:
Appropriate generic use Clinical abuse/misuse disease-drug interactions that should not be used Interactions between different drugs Incorrect length of time spent receiving therapy Inappropriate amount of prescribed medication Utilization of formulary drugs where possible and appropriate Over and underutilization Whether or whether there is therapeutic overlap and/or appropriateness
An illustration of a retrospective DUR may be the discovery of a group of patients whose therapy does not conform to the established criteria.
[Citation needed] For instance, a pharmacist may identify a group of asthma patients who, based on both their medical and pharmacy histories, need to be receiving orally inhaled steroids. These individuals would fall into the first category.
After gathering all of this information, the pharmacist can next advise physicians to make use of the medications that are indicated.
What is the difference between due and Dur?
Drug Utilization Reviews (DUR), also known as Drug Utilization Evaluations (DUE) or Medication Utilization Evaluations (MUE), are defined as an authorized, structured, ongoing review of healthcare provider prescribing, pharmacist dispensing, and patient use of medication.
Which of the following issues is the most likely target of a dur?
Study guide for the PTCB Exam 2021
|Which of the following issues is the most likely target of a DUR?
|According to the Institute for Safe Medication Practices (ISMP), which of the following are considered look-alike/sound-alike medications?
|Glyburide and Glipizide
What does Dur reject code mean?
DUR codes, which stand for drug utilization review codes, are occasionally necessary in order to bypass some rejections. Because these numbers vary from prescription to prescription, it is typically safer to call the insurance company and ask them for the correct sequence of codes.
You may do this by calling their customer service line. In addition to this, insurance reject messages may additionally provide the code that should be entered in the appropriate field. There are three components that make up a DUR code.
These are the Conflict code, the Professional Service code, and the Result of Service code. Go to any SIG line and enter the following information there to send the DUR code: /DURxxyyzz xx = Conflict code Field 439-E4 yy of the NCPDP is referred to as the Professional Service Code (Formerly Intervention code) Result of Service Code is what is stored in the NCPDP field 440-E5 zz (Formerly Outcome code) Field 441-E6 of the NCPDP.
What are the types of utilization review?
Drug Utilization Review (DUR)
A utilization review will typically include a prospective, a contemporaneous, and a retrospective evaluation.
What are Dur edits?
Drug usage review, often known as DUR, is a procedure that examines various pharmaceuticals in terms of their potential use by a particular member. Some examples of DUR changes are pregnancy warnings, therapeutic duplication precautions, age precautions, dosage range precautions about medication interactions, and gender compliance edits.
What is pharmacy reject code 88?
Reject Code 88 (DUR Reject Error) 1. The sort of possible therapeutic issue that was found by the Medi-Cal Rx claims adjudication system and returned on a claims response is reflected by the Reason for Service Codes. 2.
What is a dur PPS code?
When it is determined that the amended drug utilization review (DUR)/professional pharmacy service (PPS) codes that have been supplied are suitable medically, dispensing pharmacists should use their clinical expertise and judgment to address and override the issues with the codes using them.
What is drug utilization evaluation due?
A drug utilization review, also known as a drug use evaluation (DUE), is a qualitative analysis of medication usage, prescription, and member fill patterns that helps evaluate whether or not pharmacological therapy is appropriate.
What does duplicate therapy mean?
Any samples provided are meant solely for illustrative reasons. When healthcare professionals order more than one drug for the same indication, this is an example of therapeutic duplication. Even though this is a practice that can be followed, more clarity is needed to determine when one agent should be administered over another, whether both agents are to be given at the same time, or whether one therapy was supposed to replace an existing therapy but wasn’t discontinued in the correct manner.
- Such orders are rather prevalent in prescriptions for analgesics and antiemetics, but they can also be seen in prescriptions for other types of drugs (e;
- anti-hypertensives, anticoagulants, etc;
- ) When more than one medicine is ordered for the same indication, there has to be a system in place that can assess whether or not the ordering of several agents for the same indications is the result of an inadvertent prescription error or a purposeful attempt at multi-modal therapy;
According to the guidelines set by the Joint Commission, medicine orders must be approved by a pharmacist. The investigation will focus in part on determining whether or not therapeutic duplication is present. After this has been determined, it is imperative that both the pharmacist and the nurse have a crystal clear comprehension of the goals that the prescriber had in mind.
In order to guarantee effective communication, organizations may employ resources like as regulations, the technology contained inside electronic medical records, or any other method deemed appropriate.
The goal is to make certain that all members of the patient care team who are involved in medication management have access to medication orders that are both understandable and correct. If it was the intention that both drugs be delivered and the policy of the organization allows for these orders, then both the pharmacy that prepares the prescription and the personnel that administers the medication need to have clear advice provided to them.
When a patient is administered various antiemetic medications, for instance, there has to be a thorough comprehension of the following concerns:
Was it the prescriber’s intention to make sure that the pharmacist, as well as the person who was providing the drug, was aware of all of the ordered medications that were given? When, based on the intentions of the prescriber, does the administering physician provide each agent?
Medication Management MM is a chapter from the manual that covers hospitals and hospital clinics.
The 30th of September in 2020 is the date of the first publication. This FAQ about Standards was initially made available for public use on this date. The content of this page was most recently revised on October 21, 2021.
What is route in medication?
It is common practice to categorize a medicine’s administration route according to the site where the substance is delivered; for example, oral or intravenous medication administration routes. The administration method that is selected for a certain prescription is determined not only by the patient’s level of comfort and likelihood to take the prescribed dose, but also by the pharmacokinetic and pharmacodynamic characteristics of the drug.
What is a dur at CVS?
Evaluation of Drug Consumption (DUR).
What medication is most likely to lead to impaired driving incidents?
Benzodiazepines, which are taken for anxiety or sleep problems, and opiates, which are recommended for pain management, are the two prescription medicines that are most frequently discovered in drivers who have been gravely wounded or killed.
What information might the pharmacist be looking for when reviewing a patient’s record?
Conduct an analysis of the pertinent health data, which may include medical history, information on health and wellbeing, the results of biometric tests, and the findings of a physical exam. Consider if each drug is suitable, whether it is effective, whether it is safe, and whether the patient takes it as prescribed.
What is a submission clarification code?
When a claim is being prepared for submission (or resubmission), it might benefit from having Submission Clarification Codes (SCC) added to it. These codes give third-party payers with additional information on the dispensing event. They are put to use to either proactively avoid claim rejections or to override them.
What is drug use evaluation?
Drug Use Evaluation (DUE) is a methodical methodology that evaluates the appropriateness, safety, and efficacy of a medicine to enhance patient care. DUE stands for “drug use evaluation.” 11 Through the provision of treatments that are both effective and economical, optimizing drug use has the potential to cut down on the growth of antimicrobial resistance and to bring down the total expenditures of health care.
- 11 DUEs have historically consisted of conducting retrospective evaluations of patient health data using paper-based methods;
- Because the information must be acquired, examined, and reentered into an electronic format manually, this process is inefficient and requires a significant amount of human effort;
Other possible negatives include the possibility that some material is missing, as well as an excessive dependence on the investigators’ interpretations of the data that has been stored. In addition, the findings of retrospective DUEs may not be representative of how the medicine is currently being used.
What does Ncpdp stand for?
Every registered pharmacy in the United States and its territories has been given this one-of-a-kind national identification number by the National Council for Prescription Drug Programs (NCPDP).