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Protocol Development & Quality Improvement

Jaime Robenolt Gray ~3 min read Module 4 of 20

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Protocol Development and Quality Improvement

IV.MEDICATION USE EVALUATION

A.TJC requires medication use evaluations (MUEs) to be completed to monitor the safety of medications.

ASHP published guidelines on performing a MUE in 2021.

B.MUEs and DUEs are often used synonymously. Both DUEs and MUEs are PI and QA methods that ensure

optimal medication therapy management and improve patient safety and outcomes.

C.A DUE is drug- or disease-specific, focusing specifically on the criteria-based assessment of the medication

use process and prescribing, whereas an MUE provides a broader scope that focuses on a drug or class of

drugs, the process(es), and the outcome, with a specific emphasis on improving patient outcomes. MUEs

focus on several elements of the medication process/use such as prescribing, pharmacist medication order

validating or verifying, dispensing, preparing, administering, monitoring, patient education, and outcomes.

D.ASHP Guidelines on MUEs: Include a performance improvement framework to improve safety, efficacy,

quality, and efficiency in patient care.

An example of a performance improvement framework is FOCUS-PDSA:

Find the process to be targeted for improvement.

Organize the team that knows the process.

Clarify current knowledge of the process.

d.	Understand causes of process variation.

Five Whys: Ask “why” five times to get to the root cause.

Select process improvement.

FACES (feasibility, acceptability, cost/benefit, effectiveness, sustainability) tool

Plan: Develop a solution.

Do: Implement improvements.

Study: Evaluate the results.

Act: Determine the changes needed moving forward and implement them.

E.The sample size of the MUE depends on the type of medication data being analyzed—usually, a sample of

20–30 patients is sufficient; however, a sample of 100 or more patients may be required to analyze patient

outcomes. The primary determinant of sample size will be the threshold level. An infrequent failure to meet

the specified criteria (less than 5%) will require a large population sample size (greater than 200). If there is

a frequent failure to meet criteria (25%–50%) a smaller sample size can be used (30–60).

Critical thresholds should be set to evaluate the level of noncompliance in the process that would trigger

action (i.e., quality improvement).

G.Data collection for specific criteria can use either a yes/no format (with a section for comments) or open-

ended questions. Using CPOE and electronic medical records, the processes of data retrieval, monitoring,

and generating specialized reports have become easier.

H.The type and number of MUEs should be determined by the risk mitigated when using a medication. Broad

categories for MUEs include:

Promote optimal medication therapy

2Improve patient safety

Standardize to reduce unnecessary variation

Optimize drug therapy

HD Video Explanation — Synchronized with PDF

Starts at: minute 25 Open on YouTube