Norah Al JohanyHead of Pharmacoeconomic department General administration of pharmaceutical carenoaljohany@moh.gov.sa

Drug

Use Evaluation (DUE)

“Utilization”

Estimate cost of drug-related

morbidity and mortality

Clinical Pharmacists Affect Mortality

Seven services associated with reduced mortality rate:

1. Drug Use evaluation

2. Patient Education

3. ADR Management

4. Pharmacy Protocol Management

5. Code Team Participation

6. Admission Drug Histories

7. Participation on Rounds

Pharmacotherapy 2007;27(4):481-493

Definition

DUE 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

Medication Use Evaluation (MUE), or

Drug Use Evaluation (DUE)

Patient outcomes

Evaluating medication

use

Systematically

Monitoring

Program

Medication Use Evaluation (MUE)

Drug Use Evaluation (DUE)OR

Patient out comes &

IndividualPatient quality

of life

Inventory management

Prescribing

Preparing

Dispensing

Administration

Monitoring

Patient out comes

Formulary management

Identify Resolve Prevent

medication related problems

(MUE) process helps to

MUE Objectives

• Promoting optimal medication therapy.

• Preventing medication-related problems.

• Evaluating the effectiveness of medication therapy.

• Improving patient safety.

• Stimulating improvements in medication-use processes.

• Stimulating standardization in medication-use processes

MUE Objectives

• Enhancing opportunities, through standardization, to assess the value of innovative medication-use practices from both patient-outcome and resource-utilization perspectives.

• 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. These costs may be only partly related to the direct cost of medications themselves. When medications are selected and managed optimally from the outset, the costs of complications and wasted resources are minimized, and overall costs are decreased

• Meeting or exceeding internal and external quality standards

(e.g., professional practice standards, accreditation standards, or government laws and regulations)

MUE Objectives

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)

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)

Steps of the MUE Process

• Establish organizational authority for the MUE process and identify responsible individuals and groups.

• Develop screening mechanisms (indicators) for comprehensive surveillance of the medication-use system.

• Set priorities for in-depth analysis of important aspects of medication use.

• Inform health care professionals (and others as necessary)

in the practice setting(s) about the objectives and expected benefits of the MUE process.

• Establish criteria, guidelines, treatment protocols, and standards of care for specific medications and medication-use processes. These should be based on sound scientific evidence from the medical and pharmaceutical literature

Steps of the MUE Process

• Educate health care professionals to promote the use of criteria, guidelines, treatment protocols, and standards of care.

• Establish mechanisms for timely communication among health care professionals.

• Initiate the use of MUE criteria, guidelines, treatment protocols, and standards of care in the medication-use process.

• Collect data and evaluate care.

• Develop and implement plans for improvement of the medication-use process based on MUE findings (if indicated)

• Assess the effectiveness of actions taken, and document improvements

• Incorporate improvements into criteria, guidelines, treatment protocols, and standards of care, when indicated.

• Repeat the cycle of planning, evaluating, and taking action for ongoing improvement in medication-use processes.

• Regularly assess the effectiveness of the MUE process itself and make needed improvements.

Steps of the MUE Process

Indicators Suggesting a Need for

MUE Analysis

• Preventable adverse drug reactions, and toxicity

• Medication errors

• The medication is most effective when used in a specific way.

• Signs of treatment failures

• Pharmacist interventions to improve medication therapy

• Formulary management

• Patient dissatisfaction or deterioration in quality of life.

• Expensive medication

• frequently prescribed.

Roles and Responsibilities

in the MUE Process

• Quality management committee

• Pharmacy and therapeutics committee

should have, at a minimum, prescriber, pharmacist, nurse, and administrator representation.

• Temporary working groups may be used for.

Pharmacist’s Responsibilities in

MUE

• Plan

• Management

• goals

• Collaboration

• Education

• Reviewing individual medication orders

• Data collection

• Reporting

Resources

• The primary

• Published criteria, such as found in AJHP and ASHP’s Criteria for Drug Use Evaluation (volumes 1–4), provide.

• Computer software programs

• External standards-setting bodies, such as the Joint Commission on Accreditation of Healthcare Organizations,

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.

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

Follow up

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

Pitfalls

• Lack of authority

• Lack of organization

• Poor communication

• Poor documentation

• Lack of involvement

• Lack of follow-through

• Lack of readily retrievable data and information management

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