Maximizing Benefits With the Medication Use Evaluation Process

A medication use evaluation (MUE) is a performance measurement tool employed to audit a medication use process. The Joint Commission Standard MM.08.01.01 charges hospitals to “evaluate the effectiveness of its medication management system” through processes such as MUEs.¹ Proper execution and implementation of MUEs can ensure high-quality, patient-centered, economically sound care is delivered within health care organizations. The MUE process often involves a multidisciplinary team effort within one institution, and opportunities and action plans for improvement are often identified and executed at the single-site level. However, collaboration among hospitals and health care organizations through sharing MUE results and success stories could expand the reach of these efforts to provide a more global impact on patient care.

The involvement of a multidisciplinary team which includes pharmacists, providers, nurses, administration, and other health care team members can optimize practices through medication effectiveness evaluations and avoid medication-related issues.^2,3 Time and effort is required to conduct a high-quality MUE. Collection of data should not interfere with patient care.² To overcome the expense involved in data collection, pharmacy, nursing, or medical students can be appointed to collect data. The students receive an additional benefit through direct learning experiences, and witness the application and positive impact of MUE data on patient health care outcomes. Close supervision of pharmacy students and frequent quality checks are recommended to validate all data.² Involving students and residents in the MUE process encourages a strong foundation in clinical knowledge and team-building skills and advocates best practices.

Data can be directly pulled from electronic health records with the assistance of information technology services; however, documentation practices should be considered. One possible solution to mitigate poor documentation is to provide notification to all responsible parties of pertinent information to be included for prospective review, which improves practices. Adequate support from all members of a multidisciplinary team is necessary to implement change and ensure a successful completion of an MUE.^2,4 After the relevant information which is identified through the MUE has been reviewed, key points necessary to improve patient care could be available.⁴ Health care professionals with expertise in a specific area should contribute to the improvement process when it involves their specialty.^4-7Data review, development of action plans, and follow-up are key to the MUE process.⁵

Many avenues for data collection and analysis within a health care system or department of pharmacy exist. Organizations can review key MUE objectives and results in comparison with other in-network hospitals can further enhance patient care through collaboration, networking, and appropriate implementation of multidisciplinary processes based on MUE data. Hospitals in a local area can set up monthly or quarterly conferences where opportunities for improvement are shared. If any recommendations for provider education and one-on-one pharmacist coaching through the MUE results are identified, the information could be provided with the individuals on the call. The sharing of information would benefit other hospitals by providing not only the results but also the educational tools and resources to implement change. Through this network of resources, many processes could be identified and reformed. In addition to collaboration between hospitals in a local area, division leaders within an organization can participate in quarterly calls to increase awareness among hospitals in different areas. Gaps in therapy identified at multiple hospital locations highlight a trend to address through process developments and standard operating procedure (SOP) updates. Key opportunities to collaborate, network, and distribute dynamic MUE results among health professionals within a hospital health system are actionable items to improve outcomes.

Sharing information with multiple disciplines will improve patient safety parameters for medication use and lead to a more pragmatic, evidence-based treatment approach. Process changes through a multidisciplinary team approach create an inclusive environment. A platform such as conference calls facilitates a unique networking opportunity to exchange ideas among key interdisciplinary members within a health care network. Strategies extrapolated from a successful MUE at one location are a valuable tool for other networking facilities if the protocol is circulated and discussed at meetings. Facilities can identify key similarities, technology specifications, patient populations, and needs that are applicable to more than one facility and aid in further improvement of patient care. Resources are maximized through a collaborative approach.

The use and implementation of an MUE are both a fluid and a cyclical process. The alliance with other institutions provides pertinent data and feasible strategies for implementation. Building a camaraderie among networking facilities will help strengthen relationships and improve patient care. The application of MUE results provided through collaboration with other facilities is useful to amend a policy or address a system-wide concern when a circumstance for improvement is identified. In addition to collaborating on results and resources with other facilities, information regarding follow-up on training procedures and monitoring of employee performance should be shared to achieve the optimal outcome. A set amount of time can be set aside on conference calls to discuss quality checks, feedback, and a productive brainstorming session for future revisions. MUE results utilized as a benchmarking tool to track outcomes and progress among all health care institutions within the network hold members of the team accountable for their actions and promote future enhancements in developing safe and effective patient care models.

The MUE process is labor intensive and often requires careful extraction of hundreds of patient-specific data points. Clinically or economically important concerns often arise as a result of the MUE process, and health care institutions often change policies, procedures, or prescribing patterns as a result of these analyses. Because MUEs are often considered quality improvement projects within specific organizations, the results are rarely disseminated to other health care organizations, resulting in potentially duplicative labor efforts at multiple sites. One potential untapped benefit of the MUE process could be multicenter collaboration on MUE data and improvement plans. If adverse events or risk factors for poor clinical outcomes are detected at one site, perhaps combining single-site data with similar MUEs at other institutions could answer a larger clinical question. Such collaborations would require institutional review board (IRB) approval for data sharing and research, but the impact of the large datasets could positively impact patient care on a global level. The authors currently are unaware of any formal mechanisms for sharing MUE data results, although e-mail listservs owned by professional organizations are sometimes used by individuals to see if other sites are experiencing similar medication-related issues. The optimal platform for collaboration is yet to be determined but could potentially be executed through communication tools offered through health care corporations consisting of data sharing within a health system, or through professional organizations to facilitate collaboration between multiple organizations.

The fundamental goal of an MUE is to improve health care outcomes and ultimately the patient’s quality of life through ideal medication therapy promotion. Predetermined indications based on analyzed MUE results assist in formulary development and resource allocation and provide valuable insight for all health care members to partake in daily best practice methodologies. An effective MUE offers vital information, which a multidisciplinary team can review and analyze. Development of MUE objectives based on your facility’s needs followed by collaboration, networking, and implementation of appropriate monitoring and follow-up procedures will help improve processes and strengthen action plans. Shared knowledge between facilities and health care organizations is essential for continuous patient care improvement. Leveraging technology to provide pertinent information to multiple facilities allows hospitals to work together instead of in silos. Best practices, research questions, and answers could be discovered when IRB-approved protocols involve multiple sites. Through the initiation, collection, review, and development of action plans for MUEs, the Joint Commission standards are being met and quality improvements are being implemented.