Current status of the monitoring of medication practice.

Medication practice encompasses the processes of prescribing, dispensing, preparing, administering, and monitoring the clinical effects of medicines. The mission for hospital pharmacy services is to ensure the safe, effective, and economic uses of medicines. Medication practice measures monitor one or more of these elements. Outcome measures providing quantitative data related to the outcomes of health-system performance are the hardest to develop and use in practice. Voluntary medication-error reporting systems provide qualitative information about negative or unsafe outcomes, but the quantitative use of medication error reports should be used with great caution because only a small percentage of incidents will be reported. Trigger tools have recently been developed to enable adverse drug events to be more easily identified and provide a quantitative outcome measure of medication practice. Because outcome measures are difficult to develop and implement in practice, process and structural measures are frequently used to measure medication practice. Measures for unsafe use and negative outcomes of medication are usually used before measures of safe and effective use. Product-defect and adverse-drug-reaction reporting systems comprise the basic elements of pharmacovigilance worldwide. Hospitals and hospital pharmacy services should monitor for incidents of this type, manage the risks locally, and share these data with national and regional pharmacovigilance reporting systems where available. The development of medication practice measures are linked with the development of hospital pharmacy practice. Where practice is confined to the hospital pharmacy department, then measures will reflect this (e.g., measuring dispensing errors). Where hospital pharmacy practice has developed to provide services outside the pharmacy department, a more comprehensive set of measures can be developed. This usually involves recording pharmacist clinical interventions intended to modify medication therapy for individual patients. These interventions are usually intended to improve medicine safety, clinical effectiveness, and costeffectiveness outcomes. Advanced clinical pharmacy practice provides further opportunities to measure more definitive health care outcome data, such as clinical mortality; morbidity; and disease-specific clinicaleffectiveness measures. Like other aspects of health care monitoring, medication use in a hospital can be monitored in terms of structures, processes, and outcomes.