1. Medication Use Evaluation
Lobna AL Juffali,MSc
Clinical Pharmacy Department

2. Acronyms Associated with the evaluation of medication use
Drug use review (DUR)
1969 on prescription drugs
Retrospective evaluation to monitor medication use patterns (trends) ,quantitative
Antibiotic use Review (AUR):
1978
Retrospective evaluation of antibiotic use
quantitative
Limited to identifying pattern of use

3. Acronyms Associated with the evaluation of medication use
Drug use Evaluation (DUE) :
1986 Multidisciplinary involvement
Expansion of AUR to all drugs
evaluation of prescribing and outcome only.
Medication use evaluation (MUE):
1992
Expansion of DUE to include all medications
Evaluation expanded to include all aspects of medication use: Prescribing, dispensing,administration,monitoring,and

4. Definition
MUE is a performance improvement method that focuses on evaluating and improving medication –use processes with the goal of optimal patient outcomes
Am J Hosp Pharm. 1996;53:1953-5

5. Objectives of MUE Promoting optimal medication therapy.
Preventing medication-related problems.
Evaluating the effectiveness of medication therapy.
Improving patient safety.
Establishing interdisciplinary consensus on medication-use processes.
Stimulating improvements in medication-use processes.
Stimulating standardization in medication-use processes.

6. Objectives of MUE
Minimizing procedural variations that contribute to suboptimal outcomes of medication use.
Identifying areas in which further information and education for health care professionals may be needed.
Minimizing costs of medication therapy.
Meeting or exceeding internal and external quality standards

7. MUE
The MUE should be a systemic, multidisciplinary process focusing on continual improvement in the medication use process and patient outcomes
Simply determines if the actual use of a medication is consistent with the standards established within the criteria

8. Types Of MUE Specific medication (e.g. alteplase)
Class of medication (e.g., thrombolytics)
Medications used in the management of a specific disease state or clinical setting (e.g. thrombolytics in acute myocardial infarction)

9. Types Of MUE
Medications related to clinical event (e.g., drug therapy with in the first 24 hours for patients admitted with acute MI)
Specific component of the medication use process (e,g time from admission to administration of thrombolytics
Based on a specific outcome (vessel patency following thrombolytic administration)

10. Medication use process
Prescribing
dispensing
administration
monitoring,
systems and management control
Table 16-1

11. Ten-step process Assign responsibility for monitoring and evaluation
Delineate scope of care and service provided by the organization
Identify important aspects of care and service provided by the organization
Identify indicators, datasources ,and collection methods to monitoring important aspects of care
Establish means to trigger evaluation (e.g.,trends or patterns of use ,thresholds, etc.)

12. Ten-step process Collect and organize data Initiate evaluation of care
Take actions to improve care and service
Assess the effectiveness of actions and maintain the improvement
Communicate results to relevant individuals and groups

13. Responsibility for the medication use evaluation function
Defining which group will participate in
They must have a clear understanding that the purpose is that of improving the quality of the medication use
Each should actively participate

14. Topic Selection Based on the mission and scope of care
Effect on performance and improved patient outcomes
Selected high-volume, high-risk, or problem-prone processes medication processes
Resources and organizational priorities
Institutional priorities (initiation of new clinical programs or services)

15. Topic Selection
They should reflect the over all scope of medication use throughout the organization
Annual plan that will establish goals for new topics to be assessed and provide for follow-up on previous evaluations

16. Sources of Topic section
Medication error reports
ADRs
Advances in patient care modalities that involve changes in optimal pharmacotherapy
Disease-or diagnosis-based length of stay or cost outliers with in an organization
Purchasing reports indicating a significant increase in the use of an agent
Medications that are a key component of a process or procedure

17. Criteria Are statements of the activity to be measured
Should be based on the best practice
Appropriate for the target patient population
Supported by current literature
Multidisciplinary group develops the criteria
Should be phrased yes/no or T/F
Should avoid interpretation on the part of data collection
Assess important aspects in the use of the medication evaluated
Focus on aspects related to outcomes.

19. Types of criteria
Explicit (objective) criteria are preferred in that they are clear cut, based on a specific measurable parameters and are better suited for automation
e.g. serum creatinine evaluated every 3 days
Implicit (subjective) criteria require that a judgment be made and require appropriate clinical expertise
e.g. Renal function assessed routinely

20. Indicators
It is a quantitative measure of an aspect of patient care that is used as screening tool to detect potential problems in quality.
They are not direct measures of quality they simply work as a tool to identify potentially problematic aspects of care that require more detailed assessment in order to identify the cause.
E.g. patient discharged on > x number of prescription medications

21. Type of indicators Rate based event (how often)
Sentinel events (occur rarely but are significant impact)
Assess structure (resources ,tools, and other established attributes of the setting in which care is provided)
Assess Process (activities that take place in giving and receiving care)
Assess outcome (the effects of care on the health status of the patient or population

22. Indicators Suggesting a Need for MUE Analysis
Adverse medication events, including medication errors, preventable adverse drug reactions, and toxicity.
Signs of treatment failures, such as unexpected readmissions and bacterial resistance to anti-infective therapy.
Pharmacist interventions to improve medication therapy, categorized by medication and type of intervention.
Nonformulary medications used or requested.
Patient dissatisfaction or deterioration in quality of life.

23. Standards standards: define the performance expectations
They are set at
0% (should never happen(
100% (should always happen)
Thresholds specifying an acceptable level should be set higher then 0% and lower than 100%

24. Data collection
Prior to initiation the multidisciplinary gp must approve
Topic selection
Criteria
Patient selection process
Sample size
Sampling method
Timeframe
Data collection method
Standards of performance

25. Data Collection
Limiting the number of data collectors or automating data collection is valuable in maintaining consistency

27. Retrospective Data Collection
Reviewing the patient’s medical record after Discharge
e.g. AUR,DUR
Data source: only medical records
Allows data collection to be scheduled
Totally depends on documentation
Only to improve future patients

28. Concurrent Data collection
After the first dose and the patient is still taking the medication
Data source : medical records, staff, patent interviews
There is an opportunity to improve patient care
The need for data collection is constant and must occur within a specific timeframe, which is not always convenient
Increase number of personal and increased inconsistency

29. Prospective Data Collection
After prescribing the medication Before the patient take it
Automated
Not automated:
require the personal to be available to collect and report
Force immediate reactions with practitioners
Greatest opportunity for intervention and education
Increase the risk of negative reactions

30. Patient selection and Sample size
Unbiased
Consistent
Representative of the care provided
Sample size should be based on
The size of patient population
Frequently occurring events 5%
Rare events minimum 30 cases

31. confidentiality
It is a key component of all quality improvement initiatives
The patients and the practitioners names should anonymous

32. Data analysis
Reports should compare actual performance with expectations defined by the standards
Performance not meeting standards they are considered opportunities for improvement
Standards can be too rigorous?
Specific corrective action should be recommended.
A follow up should be started based on the needs and prevalence ,severity and frequency of the problem

33. The Report Should contain the rationale for the topic selection
Team members involved in the evaluation
Description of the patient population evaluated
Any selection criteria used
A copy of the criteria /indicators
Discussion of the results
Identification of likely causes for opportunities identified
Recommendations for corrective action
Follow –up evaluation

34. Interventions and correction actions

35. Follow up
The same criteria, standards, and sample should be used for the follow up assessment as in the initial assessment

36. Pitfalls Lack of authority. Lack of organization. Poor communication.
Poor documentation.
Lack of involvement.
Lack of follow-through
Evaluation methodology that impedes patient care
Lack of readily retrievable data and information man- agement. Existing data capabilities need to be as -