Ketorolac injection use in a university hospital

A drug-use evaluation (DUE) of ketorolac injection is described. Pharmacists at a 663-bed university hospital saved all new orders for ketorolac injection (except those from the operating, recovery, and emergency rooms) for five weeks. If an order was not in compliance with the DUE criteria, the DUE pharmacist contacted the prescriber to recommend a change. Fifty-two orders were evaluated. The daily dose exceeded that in the criteria in seven patients (13%). Conditions under which the product should be used with extra caution were present in eight patients (15%). Twelve patients (23%) received the drug for more than five days. Five patients (10%) had possible ketorolac-associated adverse effects. The pharmacist's concurrent interventions improved prescribing for correct dosage and facilitated discontinuation of the agent in high-risk patients. After follow-up educational efforts, a second audit in 28 patients showed further improvements in prescribing for correct dosage, but 25% of the patients received the drug for more than five days. No adverse effects were reported. A 72-hour automatic stop-order policy was implemented, and the fraction of patients receiving the drug for more than five days fell to 3% (of 223 pharmacy profiles reviewed). Three patients had apparent ketorolac-induced adverse effects. Educational efforts and adoption of a 72-hour stop-order policy decreased the duration of ketorolac injection therapy and the use of inappropriately large dosages and may have decreased the frequency of ketorolac-induced adverse effects.