Protocol Development and Quality Improvement
Box 1. Examples of High-Risk Medication-Related Processes Suited for an MUE in Critically Ill Patients
PADIS (ABCDEF bundle) protocols
Use of neuromuscular blocking agents
Alcohol withdrawal management
Management of supratherapeutic anticoagulation (e.g., warfarin, direct oral anticoagulants, heparin, direct
thrombin inihibitors)
Use of Ξ²-blockers in myocardial infarction
Monitoring for dysrhythmias with QTc-prolonging drugs
Antihypertensive IV-to-PO switch therapy
Antihypertensive use in acute stroke
Fluid resuscitation
Management of gastrointestinal bleeding
Use of total parenteral nutrition
Use of albumin
Hyperkalemia management guidelines
Hypomagnesemia management guidelines
Management of status epilepticus
Management of hyponatremia
Use of IV sodium bicarbonate
Vancomycin dosing and ordering serum concentrations
Aminoglycoside dosing and ordering serum concentrations
Intermittent infusions of antimicrobials (e.g., carbapenems, piperacillin/tazobactam)
Evaluation of antimicrobial dosing in CRRT or hemodialysis
Surgical prophylaxis guidelines
Antimicrobial IV-to-PO switch therapy
Management of Clostridioides difficile diarrhea
Vaccine administration
IV push medication guidelines (rate of administration and medication preparation - diluted or undiluted)
Stress ulcer prophylaxis
Insulin infusions
Hypoglycemic protocols
CRRT = continuous renal replacement therapy; PO = oral(ly); QTc = corrected QT (interval).
subcommittee and perform the MUE.
The MUE subcommittee can recommend drugs and drug processes that require an MUE to the P&T
committee; alternatively, the P&T committee can request MUEs from the MUE subcommittee.
conclusions of the MUE should be reported to the P&T committee and department chairs.
document that improvement has occurred.
improvements made remain effective and are sustained. If any new changes have occurred in the medication
use process, the MUE criteria should be reassessed and the new criteria incorporated.