Академический Документы
Профессиональный Документы
Культура Документы
Workbook
Course 206055
Table of Contents
Introduction ................................................................................................................ 3
How are Drug Utilization Review (DUR) Warnings Generated? ................................. 4
Understand the DUR Engine ...................................................................................... 4
Hard Stop vs. Soft Stop .............................................................................................. 5
DUR Clinical Module Descriptions ............................................................................. 7
Third Party DUR and Prescriber DUR ...................................................................... 13
Workflow steps that affect DUR ............................................................................... 14
Other DUR Considerations....................................................................................... 15
Next Steps................................................................................................................ 16
Payroll ...................................................................................................................... 16
Appendix: Knowledge Check Answer Key .............................................................. 17
Introduction
Drug Utilization Review (DUR) is a core clinical function that Pharmacists perform to
keep our patients safe and provide quality health care. When a prescription is
processed through RxConnect, the system checks for clinical alerts against several
DUR modules. As a Pharmacist, you are responsible for addressing all DUR warnings.
Upon completion of this course, you should be able to:
You will learn the steps to complete final verification, including DUR verification, in the
Introduction to Quality Assurance Workstation web-based training (LEARNet #206050).
This training guide is provided in a self-paced format. Answers to each knowledge
check are in the appendix at the end of this workbook.
It will take you approximately 20 minutes to complete this workbook.
Hard stop intervention codes can be entered into the system after ALL hard stops have
been viewed. The system allows the user to view soft stops before and after entering an
intervention code. The intervention codes available are:
A. Prescriber Consulted
B. Medication Review
C. Patient Consulted
Note: Hard stops can become soft stops on refills if no new DUR warnings are present. This
process is called FILTERING. When an alert is filtered, it will be noted on the screen with an
asterisk (*) and a statement.
Title Statement
Drug-Drug
Interaction
The Drug-to-Drug
Interaction Module
(DDIM) identifies
clinically significant
drug-to-drug
interactions between
the prescription
being filled and
eligible prescriptions
in RxConnect and
for enterprise
patients, Caremark
Mail order and
Specialty Mail order.
The database
covers every
product that is
approved for
marketing in the
United States. It
also covers many
commonly used
herbal and
nutritional products
available at CVS.
Geriatric
Precautions
The Geriatric
Precautions Module
identifies
medications that
cause increased risk
in patients over 65
years old.
The database
covers every
product that is
approved for
marketing in the
United States.
Eligible prescriptions
are determined by the
system, taking into
account factors like:
Fill date
Days supply
If there is another
prescription on the
profile for the same
drug
Some drugs will be
screened indefinitely
once on a patient
profile (for example,
nitroglycerin)
If a compound is
being dispensed, the
DUR Engine will
check drug
interaction codes for
each individual
ingredient
Title Statement
Drug
Condition
Alerts
The Drug-Condition
Contraindications
Module identifies
clinically significant
drug-condition
interactions.
Severity Level 1
interactions are absolute
contraindications. They
require RPh professional
judgment to fill, prescriber
authorization and
documentation
Severity Level 2
interactions are relative
contraindications.
Pharmacists should
exercise professional
judgment and review the
profile/contact the patient/
consult the physician as
required
Severity Level 3
interactions are warnings.
Pharmacists should
assess the risk and act as
needed
The database
covers every
product that is
approved for
marketing in the
United States.
Drug
Allergy
Alerts
Title Statement
Duplicate
Therapy
The Duplicate
Therapy Module
identifies
medications with
overlapping
therapeutic or
pharmacological
uses that can create
added toxic effect,
adverse events or
therapeutic
redundancy without
benefit for the
prescription being
filled and eligible
prescriptions in
RxConnect and for
enterprise patients,
Caremark Mail order
and Specialty Mail
order.
The database
covers every
product that is
approved for
marketing in the
United States.
Eligible prescriptions
are determined by the
system, taking into
account factors like:
Only systemic
drugs are
considered for
duplicate therapy
Fill date
Days supply
If there is another
prescription on the
profile for the same
drug
*Note Some
therapeutic classes
have thresholds that
must be met before
duplicate therapy will
trigger. For example, a
patient must be on
more than 2
anticonvulsants for the
system to warn
against duplicate
therapy.
Title Statement
Minimum /
Maximum
Dosing
The database
covers every
product that is
approved for
marketing in the
United States.
10
Title Statement
Pediatric
Precautions
The Pediatric
Precautions Module
identifies
medications that
cause increased risk
in patients under 15
years old.
If reported pregnant:
o Category X - The drug
SHOULD NOT BE
DISPENSED.
Pharmacists must notify
the physician.
o Category D or Severity
1- requires RPh
professional judgment to
fill, prescriber
authorization and
documentation
o Category C or Severity 2
- Pharmacists should
exercise professional
judgment and review the
profile/contact the
patient/ consult the
physician as required
If childbearing age:
o Pharmacists should
determine pregnancy
status and update in
RxConnect. Pharmacists
should exercise
professional judgment
and review the
profile/contact the
patient/ consult the
physician as required
The database
covers every
product that is
approved for
marketing in the
United States.
Pregnancy
Precautions
The Pregnancy
Precautions Module
identifies
medications that
cause increased risk
in patients reported
as pregnant, or
those of
childbearing age.
The database
covers every
product that is
approved for
marketing in the
United States.
11
Title Statement
Lactation
Precautions
The Lactation
Precautions Module
identifies
medications that
cause increased risk
in patients reported
as breastfeeding, or
those of
breastfeeding age.
The database
covers every
product that is
approved for
marketing in the
United States
12
Title Statement
Inferred
Condition
The Inferred
Condition Module
identifies clinically
significant drugcondition
interactions by
inferring conditions
based on drugs that
the patient is taking.
Eligible prescriptions
are determined by the
system, taking into
account factors like:
Fill date
Days supply
If there is another
prescription on the
profile for the same
drug
*Note Limited
conditions will be
inferred from
medications during a
pilot phase of the
module.
13
DUR Module
Dispensed
Quantity &
Day Supply
Minimum &
Maximum
Dosing
Allergy
Symptoms and
Notes
Drug Allergy
Module
OPTIMIZING DUR
Example
14
DUR Module
OPTIMIZING DUR
Example
Pregnancy
Status
&
Due Date
Pregnancy
Precautions
Lactation
Status
Lactation
Precautions
Course Completion
Congratulations! You have completed the Understanding DUR Management workbook.
15
Next Steps
In order to receive credit for the completion of this workbook, you need to complete an
on-line assessment to test your understanding of what you have learned. This
assessment is available from the Understanding DUR Management course description
page on LEARNet. Please contact your Trainer with any questions/concerns.
Payroll
In order to be paid properly for completing this workbook and assessment, your time for
completing this training should be submitted on your Weekly Pharmacist Payroll Sheet as
part of regular operating hours.
*Include time spent reading the workbook and completing the on-line
assessment.
16
17