8.1 Prospective Drug Utilization Review: Oregon's Eight Categories, Documentation & Who May Perform It
Key Takeaways
Under OAR 855-115-0140, an Oregon pharmacist must review the patient record before dispensing each prescription.
Oregon's eight DUR categories are over- or under-utilization, therapeutic duplication, drug–disease and drug–drug interactions, incorrect dose or formulation, inappropriate duration, drug–allergy interactions, and abuse or misuse.
When an Oregon pharmacist finds a DUR concern, they must mitigate or resolve it and document the steps taken and the outcome.
Oregon technicians and first-year interns may not conduct DUR, and technicians may not override clinical alerts.
An Oregon patient record must include date of birth, preferred language, chronic conditions and allergies.
Why this matters
Area 3.3 covers prospective drug utilization review (DUR) and, within it, PDMP reporting and access. Oregon's DUR rule is short but strict: the pharmacist must personally review the patient record before each prescription is dispensed, and must document any concern and how it was resolved.
The Oregon DUR rule (OAR 855-115-0140)
Before dispensing each prescription drug or device, a pharmacist must complete a DUR by reviewing the patient record to identify:
| DUR category | Typical exam example |
|---|---|
| (a) Over-utilization or under-utilization | Early refill of a controlled substance; a gap suggesting non-adherence to an antiepileptic |
| (b) Therapeutic duplication | Two ACE inhibitors, or an ACE inhibitor plus an ARB, from different prescribers |
| (c) Drug–disease contraindications | A nonselective beta-blocker in severe asthma; an NSAID in active peptic ulcer disease |
| (d) Drug–drug interactions | Clarithromycin with simvastatin; sildenafil with nitrates; fluconazole with warfarin |
| (e) Incorrect drug dosage or formulation | Methotrexate "daily" for rheumatoid arthritis; an extended-release product ordered to be crushed |
| (f) Inappropriate duration of treatment | Oral ketorolac beyond the labeled maximum duration |
| (g) Drug–allergy interactions | A cephalosporin in a patient with documented penicillin anaphylaxis (evaluate the history and cross-reactivity) |
| (h) Drug abuse or misuse | Overlapping opioid and benzodiazepine prescriptions from several prescribers |
When a concern is found, the pharmacist must take steps to mitigate or resolve it and document the steps taken and the outcome (OAR 855-115-0140(2)).
Who may perform DUR
- Pharmacists must personally perform the DUR for each prescription. The Board's self-inspection form says so expressly.
- Interns past their first academic year may perform DUR under supervision. First-year interns may only observe (OAR 855-120-0150).
- Technicians may not conduct a DUR or drug regimen review, and may not exercise judgment unless a pharmacist verifies it (OAR 855-125-0150). Pharmacy software can flag alerts, but a technician cannot decide whether an alert matters or override it.
The patient record behind the DUR (OAR 855-041-1165)
A DUR is only as good as the patient record. The pharmacist must make a reasonable effort to obtain and keep:
- The patient's full name, address, phone, date of birth and gender.
- The patient's preferred language for communication and labeling.
- Chronic conditions and known allergies, drug reactions and idiosyncrasies.
- A list of prescriptions dispensed by this pharmacy (drug, strength, quantity, date, prescriber and Rx number).
- Pharmacist comments, and, where relevant, weight, other conditions and OTC or other drugs in use.
Oregon checks the patient-record elements on its self-inspection form for both new and existing patients.
A practical DUR workflow
- Validate the prescription (Chapter 5): prescriber authority, required elements and legitimacy.
- Review the profile, plus the PDMP when clinically indicated (section 8.2).
- Classify each alert or concern using the eight categories, and judge its clinical significance.
- Resolve it: contact the prescriber, counsel the patient, adjust within the pharmacist's own authority (for example, a protocol), or decline to dispense.
- Document the concern, who was contacted, the decision and the outcome.
DUR in special settings
- Remote dispensing site pharmacies, kiosks and lockers: the pharmacist performs the DUR before the drug is released, through the telepharmacy system or before stocking (OAR 855-139, 855-141, 855-143).
- Central fill and remote processing: the outlet's policies must say how a pharmacist completes and documents a DUR on each prescription, new and refill. Remote processing pharmacies may perform the DUR on behalf of the primary pharmacy (OAR 855-041-3100 to -3130).
- Institutional practice: chart orders get pharmacist review under hospital policies. OAR 855-115-0140 applies to dispensing, and the PIC sets institutional procedures.
Tip
A DUR concern doesn't always require calling the prescriber. A chelation interaction between ciprofloxacin and calcium can be resolved by counseling on dose spacing, then documented. A daily methotrexate order for rheumatoid arthritis, or sildenafil with isosorbide mononitrate, needs prescriber clarification before dispensing. Changing the directions yourself is not an option.
Exam scenario
A patient presents a new order for clarithromycin 500 mg twice daily. The profile shows simvastatin 40 mg daily from another prescriber, and a technician says "the system flagged it but it's just a moderate alert." The pharmacist, not the technician, must evaluate the alert. Clarithromycin is a strong CYP3A4 inhibitor and is contraindicated with simvastatin. The pharmacist contacts the prescriber, who switches to azithromycin or advises holding simvastatin during therapy. The pharmacist documents the concern, the call and the resolution under OAR 855-115-0140(2).
Which of the following is one of the eight DUR categories listed in OAR 855-115-0140?
Formulary tier placement
Generic availability
Inappropriate duration of treatment
Prior authorization status
A certified technician clears a 'moderate' drug interaction alert so a prescription can move to the pharmacist's product-verification queue. Is this compliant in Oregon?
No; DUR, including evaluating interaction alerts, must be performed by the pharmacist, and technicians may not conduct DUR or exercise unverified judgment
Yes, technicians may clear moderate alerts if the PIC allows it in policy
Yes, if the technician documents their initials
Yes, because severe alerts are the only ones requiring pharmacist review
After identifying a serious interaction and calling the prescriber, who changes therapy, what must the pharmacist do under OAR 855-115-0140(2)?
Nothing further, because the prescriber made the change
Report the interaction to the Board within 10 days
Obtain the patient's written consent to the new drug
Document the steps taken to resolve the concern and the outcome
Sections you finish are checked off in the contents.