What are guided-use strategies?

Guided-use strategies can improve therapeutic outcomes, prevent adverse events, and reduce costs.

Examples of strategies

• Established-use criteria, patients must meet the established criteria before the medication is dispensed. Occasionally, the patient does not meet the criteria but requires these medications. Policies must encompass these situations. Useful when medications are in short supply.
• Restricting drug use to service, only approved services can dispense the drug.
• Useful for drugs commonly inappropriately used or carries severe adverse effects.
• Limiting the use of the drug to specially trained individuals. Appropriate for the inherently dangerous drugs which require specific training to use.
• Designating medications for use in a specific area. Helpful when administrating medication requiring specific equipment or skills to use safely.
• Approval of medical director before drug use. For high-cost medication with little or no role in the care of patients, but a prescriber prefers to use it on a nonformulary basis.

Development is key

The development of drug therapy guidelines is the core function of PTC. Guidelines influence prescriber behaviour passively, primarily through education. Guidelines should be evidence-based but may incorporate expert opinions of prescribers within a practice setting.

When adopting policies, policymakers should not assume that all guidelines are necessarily evidence-based. They should still review guidelines thoroughly before implementing them. Local expertise must also be incorporated into decision-making. The guidelines and formulary must be consistent and applicable to the majority of cases. Avoid recommending nonformulary medications, but guidance to their appropriate use must be provided.

Dissemination and implementation of guidelines in the practice environment must be carefully executed. Guidelines only change behavior only when they are accessed, read, accepted, and put into practice. Exhaustive communication about the availability of guidelines is necessary.

Every guideline should include a time frame for future review and revision. If resources are not available to properly update and revise an older guideline, the guideline should be retired.

Share and learn:

Who are the policymakers in your hospital?

Are these guidelines developed locally, or adapted from an international source?