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Tubular reabsorption, a process occurring post-glomerular filtration of drugs in the renal tubule, is a critical determinant of drug half-life. During the process of renal excretion, as the glomerular filtrate progresses to the distal convoluted tubule (DCT), drugs that are highly permeable, lipophilic, and nonionized undergo passive reabsorption from the tubular fluid into the surrounding peritubular capillaries. This reabsorption process restricts their elimination through the kidneys. This...
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A Pharmacist-Led Process to Monitor Discrepant Urine Drug Screen Results.

Joseph Berendse1,2, Olivia Sharp2, Whitney Hutchison2

  • 1South Dakota State University College of Pharmacy & Allied Health Professions, Brookings.

Federal Practitioner : for the Health Care Professionals of the VA, Dod, and PHS
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PubMed
Summary

A pharmacist-led review of urine drug screens (UDS) improved patient care by facilitating prescriber collaboration and optimizing confirmatory testing. This process helps manage controlled substance prescriptions effectively.

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Area of Science:

  • Clinical Pharmacy
  • Health Services Research
  • Pharmacovigilance

Background:

  • Urine drug screens (UDS) are crucial for monitoring controlled substance prescriptions, especially opioids.
  • Misinterpretation of complex UDS results can negatively affect patient-clinician relationships.
  • The Veterans Health Administration introduced a clinical dashboard to identify discrepant UDS results compared to patient medication lists.

Purpose of the Study:

  • To implement and evaluate a pharmacist-led process for reviewing discrepant UDS results.
  • To assess the impact of this process on prescriber collaboration and confirmatory testing.
  • To improve the management of controlled substance therapy in a rural healthcare setting.

Main Methods:

  • A quality improvement project involving weekly clinical pharmacist reviews of the UDS dashboard.
  • In-depth review of significant discrepant UDS results from June to September 2022.
  • Tracking pharmacist interventions, including prescriber consultations and prescription drug monitoring program queries.

Main Results:

  • 700 UDS performed, with 60 patients (approx. 8.6%) requiring in-depth review due to significant discrepancies.
  • Pharmacist interventions included 39 prescriber collaborations (65%) and 25 prescription drug monitoring program queries (42%).
  • An average of 4 patients per week required review, taking approximately 14 minutes each.

Conclusions:

  • A pharmacist-led monitoring process for discrepant UDS results enhances collaboration with prescribers.
  • This initiative positively influenced the utilization of confirmatory UDS testing.
  • The process demonstrated value in a rural Veterans Affairs health system for managing controlled substance therapy.