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Medication Use Evaluation
Lobna AL Juffali,MSc
Clinical Pharmacy Department
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
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
Definition
MUE is a performance improvement method that
focuses on evaluating and improving medication –use
processes with the goal of optimal patient outcomes
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Am J Hosp Pharm. 1996;53:1953-5
Objectives of MUE
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Promoting optimal medication therapy.
Preventing medication-related problems.
Evaluating the effectiveness of medication therapy.
Improving patient safety.
Establishing interdisciplinary consensus on medicationuse processes.
Stimulating improvements in medication-use processes.
Stimulating standardization in medication-use processes.
Objectives of MUE
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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
MUE
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The MUE should be a systemic, multidisciplinary process
focusing on continual improvement in the medication use
process and patient outcomes
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Simply determines if the actual use of a medication is
consistent with the standards established within the
criteria
Types Of MUE
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Specific medication (e.g. alteplase)
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Class of medication (e.g., thrombolytics)
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Medications used in the management of a specific
disease state or clinical setting (e.g. thrombolytics in
acute myocardial infarction)
Types Of MUE
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Medications related to clinical event (e.g., drug therapy
with in the first 24 hours for patients admitted with acute
MI)
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Specific component of the medication use process (e,g
time from admission to administration of thrombolytics
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Based on a specific outcome (vessel patency following
thrombolytic administration)
Medication use process
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Prescribing
dispensing
administration
monitoring,
systems and management control
Table 16-1
Ten-step process
1.
2.
3.
4.
5.
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.)
Ten-step process
6.
7.
8.
9.
10.
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
Responsibility for the medication use
evaluation function
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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
Topic Selection
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Based on the mission and scope of care
 Effect on performance and improved patient
outcomes
 Selected high-volume, high-risk, or problemprone processes medication processes
 Resources and organizational priorities
 Institutional priorities (initiation of new clinical
programs or services)
Topic Selection
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They should reflect the over all scope of medication use
throughout the organization
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Annual plan that will establish goals for new topics to be
assessed and provide for follow-up on previous
evaluations
Sources of Topic section
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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
Criteria
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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.
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
Indicators
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It is a quantitative measure of an aspect of patient care
that is used as screening tool to detect potential
problems in quality.
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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
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Type of indicators
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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
Indicators Suggesting a Need for MUE
Analysis
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Adverse medication events, including medication errors, preventable
adverse drug reactions, and toxicity.
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Signs of treatment failures, such as unexpected readmissions and
bacterial resistance to anti-infective therapy.
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Pharmacist interventions to improve medication therapy, categorized
by medication and type of intervention.
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Nonformulary medications used or requested.
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Patient dissatisfaction or deterioration in quality of life.
Standards
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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%
Data collection
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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
Data Collection
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Limiting the number of data collectors or automating data
collection is valuable in maintaining consistency
Data Collection
Retrospective
Concurrent
Prospective
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
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Concurrent Data collection
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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
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
Patient selection and Sample size
Patient selection
 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
confidentiality
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It is a key component of all quality improvement
initiatives
The patients and the practitioners names should
anonymous
Data analysis
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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
The Report
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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
Interventions and correction actions
Interventions
Educational
Restrictive
Interventions
Process Changes
Follow up
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The same criteria, standards, and sample should be
used for the follow up assessment as in the initial
assessment
Pitfalls
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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 management. Existing data capabilities need to be as -