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Written By: Abier Hamami. RPH.CPHQ
- Medication Use Evaluation Process
Medication Use Evaluation MUE is defined as a criteria-based monitoring, evaluation, and analysis of medication use patterns and practices with the aim to improve patient outcomes. It is a component of the health care organization’s quality improvement program mandated to a great extent by the Joint Commission on Accreditation of Health Care Organizations JCAHO.
MUE, as a term introduced officially in 1994, is replacing what we used to call drug use evaluation (DUE) as it includes all the objectives of the DUE process in its broadest application, with an emphasis on improving patient outcome. Accordingly, MUE may be applied to a specific medication, a class of medications, medication related to a clinical event, a disease, a medication-use process, or specific outcomes.
MUE assures the appropriate, cost effective, and safe use of medications. It also stimulates improvement, standardization, and minimizes procedural variations in the medication use process.
In order for MUE process to be applied in any health system, it must be conducted as a structured, organizationally authorized program, managed by an interdisciplinary team that includes physicians, pharmacists, nurses, quality staff, and other health professionals. Usually it is over sighted and managed by the pharmacy and Therapeutics Committee (P&T).
The MUE process is based on the performance improvement model or outline that involves planning, monitoring, analyzing, and then improving any process. This could be further explained in the following steps:
1- Assignment of roles and responsibilities of personnel involved in the MUE process as the team or committee coordinator or leader, data collector, other healthcare professionals as physicians, nurses and quality staff.
2- Selection of the MUE topic, usually medications and medication therapy problems that most significantly affect the care of patients will be identified for evaluation considering the following:
· Events that occur frequently or affect large numbers of patients.
· Events that place patients at risk.
· Problem-prone issues for either patients or care givers.
· High-cost agents which also meet other selection criteria.
Other considerations will include the feasibility of the evaluation and the likelihood of successful impact on patient care. Several sources of information are commonly used to identify these medications and issues as the following:
· Medication error reports.
· Adverse drug reactions.
· Diagnosis related groups.
· Advances in patient care modalities that involve changes in pharmacotherapy.
· Length of stay or cost outliers.
· Purchasing reports.
3- Prioritization of potential topics for evaluation taking into consideration the potential for impact on patient safety and cost minimization.
4- Development of an action plan that includes specific goals of the MUE program, recommended topics for evaluation, responsibilities, and a timeline for completion. The MUE plan will then be forwarded to the Pharmacy and Therapeutics Committee for review and approval.
5- Establishment of MUE criteria for specific medications and medication-use processes based on sound scientific evidence from the medical and pharmaceutical literature. Criteria consist of different elements or indicators that evaluate each specific aspect of the use of the medication (prescribing, use, and outcome), and should be phrased in yes/no or true/false format with exceptions for an element not to be met also defined.
6- Identification of patients receiving the studied medication using the pharmacy computer system
7- Determination of the sample size for the evaluation, usually the JCAHO Criteria is followed which states; if the average number of cases per quarter is more than 600, at least 5% of cases are reviewed, if the average number of cases per quarter is fewer than 600, at least 30 cases are reviewed, and if there are fewer than 30 cases per quarter, then 100% of the cases are reviewed. After determining the sample size patients should be randomly, and unbiased selected to represent the appropriate population. For example; identification of every second or every fifth patient for whom the medication is prescribed, or selection of patients with even medical record numbers.
8- Development of a data collection form either manually or electronically based on the pre-determined, and approved criteria. These forms must be handled as confidential information to ensure patient privacy.
9- Analysis of data, and development of results summary. The MUE results summary may contain the following information:
Rationale for the topic selection.
Team members involved in the evaluation.
Total number of patients enrolled.
Data collection period.
A list of prescribing services involved.
A summary of how many patients met or did not meet each element of the criteria or who met exceptions.
A narrative description of the results.
A list identifying the main problems identified
Causes or contributing factors for each of the main problems identified.
A discussion of any limitation(s) identified.
A discussion of any notable trends, patterns, or findings associated with data collection that were not addressed in the criteria.
An economic and cost analysis.
10- Development of recommendations and corrective actions, which could include the following:
- In-service education.
· Poster displays.
· Written education or computerized order entry educational screens.
· Reporting MUE results via the Drug Information Center newsletter.
· A change in the formulary status of the reviewed drug (e.g. restriction of drug use).
· A change in current policy or development of a new policy.
· A change or update of current guidelines or protocols.
· Implementation of new services or acquisition of new equipments.
11- Evaluation of corrective actions effectiveness, by conducting a follow-up MUE which is a repeat of the initial evaluation using the same criteria after a specified period of time.
12- Communication of the results and recommendations to the appropriate Department Chair, Division Director, and Quality Improvement (QI) Coordinator for each clinical department identified through the MUE process.
ASHP Guidelines on Medication Use Evaluation/Best Practices for Hospitals & Health-System Pharmacy: Position &Guidance Documents of ASHP.2005-2006 Edition.
Mark A.Ninno. Sharon Davis Ninno. Chapter Fiften:Quality Improvement and The Medication Use Process/ Drug Information: A guide for Pharmacists. Patrick M.Malone 2001
Medical University of South Carolina MUSC Pharmacy Services: MUE Policy www.musc.edu/pharmacyservices/PnP/g01.pdf Accessed Feb 2006