18. Analysis of Drug Utilization Review (DUR) Alerts and Pharmacist Actions Taken to Improve Accuracy of DUR Evaluations

Background: Drug utilization review (DUR) is a continuous process that evaluates prescribing, dispensing, and medication use, focusing on safety and appropriateness against established criteria. Pharmacists play a crucial role in DUR, leveraging these systems within medication therapy management to identify potential issues such as drug interactions, contraindications, and precautions. This helps improve patient outcomes and reduce healthcare costs.

Despite these benefits, DUR systems can contribute to alert fatigue, which occurs when clinicians encounter excessive or irrelevant alerts. This fatigue may lead clinicians to overlook significant warnings, potentially compromising patient safety. It is crucial for DUR alerts to be relevant and evidence-based to reduce this issue. However, discrepancies often exist between alert significance and clinical relevance, contributing to unnecessary fatigue.

Limited research addresses how DUR alerts can be refined. The Institute for Safe Medication Practices (ISMP) recommends periodic evaluations of pharmacy systems to reduce non-significant alerts, yet there is little guidance on best practices. This study aims to address this gap by analyzing DUR alerts generated in the outpatient pharmacy medication dispensing system within our health system. By examining pharmacist responses and documentation, we aim to provide actionable recommendations to optimize alert frequency, type, and presentation that can be applied to all pharmacy medication dispensing systems, including those used in infusion practice settings. Ultimately, this will support improved clinical review processes and enhance medication safety regardless of specific medication dispensing system.

Purpose: The purpose of this research is to evaluate the efficacy of specific DUR alerts triggered in our medication dispensing system for interventions made by outpatient pharmacists to optimize the system build for future DUR alerts. We intend these results to be widely applicable to other medication dispensing systems that also trigger DUR alerts.

Methods: This is a retrospective study conducted across nine outpatient pharmacies within our health system. Inclusion criteria were limited to DUR alerts for all medications generated in our medication dispensing system (Epic Willow Ambulatory) from October 1, 2024, to December 31, 2024. A three-month period was selected to capture patients who receive 90-day supplies of medication.

Institutional Review Board (IRB) approval was obtained prior to data collection. Data collected included pharmacy location, date and time when DUR alert was triggered, medications involved, alert name, alert category (e.g., dose, drug-allergy, drug-food, duplicate therapy, lactation, pregnancy), and alert severity (e.g., low, medium, high, very high). Additionally, pharmacist responses to each alert, including reason for overriding the alert (e.g., clinician reviewed, benefit outweighs risk, dose appropriate, inaccurate warning) and free-text comments, were obtained.

Data analysis is underway. Descriptive statistics will be performed to characterize the type, frequency, and presentation of DUR alerts. Actions taken and documentation provided by pharmacists when reviewing triggered DUR alerts will be analyzed with qualitative summaries.

Results: In this three-month period, a total of 16,653 patients were served across our health system’s nine outpatient pharmacies. A total of 93,010 alerts were overridden collectively by 80 pharmacists who staff these pharmacies.

These are preliminary results, and data analysis is ongoing. Full results will be provided upon submission of the poster presentation.

Discussion: Preliminary results demonstrate that a large number of alerts are triggered by our medication dispensing system and reviewed by outpatient pharmacists. Further discussion will be provided upon submission of the poster presentation after additional data analysis is complete. This data will inform recommendations for improving the type, frequency, and presentation of DUR alerts triggered in our medication dispensing system to optimize pharmacist clinical review.

Although the data and results focus on outpatient pharmacies, they are expected to be applicable to all pharmacy practice settings, including infusion pharmacy.

Conclusions: This is the first study we are aware of that aims to systematically review DUR alert data in a medication dispensing system and propose recommendations to optimize system build for future DUR alerts. Next steps include completion of data analysis, review of pharmacist DUR alert response, and proposal of recommendations for improving the type, frequency, and presentation of DUR alerts triggered in our medication dispensing system. We hope that findings from this study will help other pharmacy services conduct similar reviews within their respective dispensing platforms. Since DUR alert review is applicable to all pharmacy practice settings, the results and insights gained from this study are expected to be mirrored to infusion pharmacy dispensing systems.