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ASHP Guidelines on Medication-Use Evaluation

Medication-use evaluation (MUE) is a performance improvement method that focuses on evaluating and improving medication-use processes with the goal of optimal patient outcomes. MUE may be applied to a medication or therapeutic class, disease state or condition, a medication-use process (prescribing, preparing and dispensing, administering, and monitoring), or specific outcomes.¹ Further, it may be applied in and among the various practice settings of organized health systems.

MUE encompasses the goals and objectives of drug-use evaluation (DUE) in its broadest application, with an emphasis on improving patient outcomes. Use of “MUE,” rather than “DUE,”² emphasizes the need for a more multifaceted approach to improving medication use. MUE has a common goal with the pharmaceutical care it supports: to improve an individual patient’s quality of life through achievement of predefined, medication-related therapeutic outcomes.^3,4 Through its focus on the system of medication use, the MUE process helps to identify actual and potential medication-related problems, resolve actual medication-related problems, and prevent potential medication-related problems that could interfere with achieving optimum outcomes from medication therapy.

In organized health systems, MUE must be conducted as an organizationally authorized program or process that is proactive, criteria based, designed and managed by an interdisciplinary team, and systematically carried out. It is conducted as a collaborative effort of prescribers, pharmacists, nurses, administrators, and other health care professionals on behalf of their patients.

MUE Objectives

Some typical objectives of MUE include

• Promoting optimal medication therapy.
  
• Preventing medication-related problems.
  
• Evaluating the effectiveness of medication therapy.
  
• Improving patient safety.
  
• Establishing interdisciplinary consensus on medication-use processes.
  
• Stimulating improvements in medication-use processes.
  
• Stimulating standardization in medication-use processes.
  
• 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).

Steps of the MUE Process

While the specific approach varies with the practice setting and patient population being served, the following common steps occur in the ongoing 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.
  
• 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.

Selecting Medications and Medication-Use Processes for Evaluation

Medications or medication-use processes should be selected for evaluation for one or more of the following reasons:

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