Establishing MUE process requires sound goals and data collection tool
Establishing MUE process requires sound goals and data collection tool
Select criteria for comparing drugs
Pharmacy leaders need to take charge of the medication use evaluation (MUE) process by identifying a lead person, establishing a process for regular evaluations, and then creating an appropriate tool.
"It's reasonable for mid-sized community hospitals to shoot for quarterly medication use evaluations," Geoffrey C. Wall, PharmD, FCCP, BCPS, CGP, an associate professor of pharmacy practice at Drake University in Des Moines, IA, and an internal medicine clinical pharmacist at Iowa Methodist Medical Center, also in Des Moines.
"We've managed to get two per year done and sometimes three at a community hospital," Wall says.
Also, someone must be identified as the point person for the MUE process.
"Whether it's the director of pharmacy or the clinical coordinator or the floor pharmacist who does a lot of expensive work, someone should be in charge," Wall suggests.
Pharmacy leaders should establish criteria for measuring new medications against existing drugs, he says.
"There should be several outcomes you'll look at with this medication, and you should compare the use of this drug to the baseline, which sometimes is very easy," Wall says.
Use available resources
If the type of medication already has guidelines available, then these are good references, he notes.
For example, if the MUE will compare IV proton pump inhibitors, there already are guidelines for the use of these, Wall says.
"So I take out those guidelines and say, 'How are we doing against these,'" Wall says. "Is my hospital doing what the guidelines say you should do?"
When there are no established or published guidelines, pharmacy directors should conduct an in-depth literature search and develop criteria based on best evidence or compare the hospital's outcomes to published outcomes, he adds.
"There are more and more published clinical guidelines out there, and more professional medical bodies are doing a good job of that," Wall says.
Sometimes there might be very little to go on. When drotrecogin was approved, there was only one study with which an MUE program could compare the hospital's outcomes with published outcomes, he says.
It's important to design a practical data collection instrument.
This could be a piece of paper or an electronic database, Wall says.
Data collection instruments should give the basic patient demographics, including age, gender, and also include what the patient was admitted for, and the patient's outcomes, Wall says.
"That means you have to go back to the chart and medical records and research it like a retrospective study," Wall explains. "If the computer database shows 50 patients who received drotrecogin last year, then I will compare their charts with the current patients' charts."
The data collection instrument should collect information about rehospitalizations, mortality, and as many hard outcomes as the system will allow, he says.
"With electronic medical records much of that stuff is on-line, and it makes collection of data much easier if you don't have to slog through paper charts," Wall says.
If pharmacy directors have an effective data collection instrument and clear objectives, then it will work.
"The key piece is to sit down with your outcomes and ask yourself, 'What is the minimum amount of information I need to figure out this outcome?'" Wall suggests.
With electronic medical records, pharmacists potentially could access a variety of details, including many that are unnecessary for the MUE task, he says.
"I only need the patient's age, weight, and creatine to figure out if the right dose was given to the patient, so I don't need to know the liver function test or anything else about the patient," Wall says. "So there's no need to collect additional data."
Another factor that could impact outcomes is cohort selection.
"Make sure the cohort you're looking at will be representative of what you'll get," Wall says. "You might pull charts from the types of patients who are not representative of what you're trying to figure out."
The key is to pull enough charts to get a good feel for the situation, but not so many charts that the pharmacy director will not have the time or resources to review each, Wall adds.
These could be selected through a randomized number generator, Wall says.
"I think people think it's rocket science, and it's not," he adds. "Once you get a couple of MUEs under your belt, they're pretty simple to do."
Pharmacy leaders need to take charge of the medication use evaluation (MUE) process by identifying a lead person, establishing a process for regular evaluations, and then creating an appropriate tool.Subscribe Now for Access
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