Medication Evaluation to Improve Treatment

A Comprehensive Guide to Medication-Use Evaluation, or MUE.

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Comprehensive Diagnostic Evaluations at J. Flowers Health Institute 

The information presented on this page is an overview of the average evaluation of this nature and is offered here as a resource. At J. Flowers Health Institute, our evaluations are customized and tailored to the individual’s needs.  We specialize in providing truly comprehensive health and wellness evaluations and a workable plan for future health to those who want to improve their quality of life.

If you would like to learn more about J. Flowers Health Institute, please do not hesitate to reach out.

We welcome any questions you have: 713.783.6655

Introduction

Why is a medication evaluation so essential to effective treatment? Medicines are crucial to our health. But, a wrong prescription or inappropriate use can turn a savior into a killer in no time. A proper prescription and sticking to your doctor's instructions remain the cornerstone of safe medicine use. Tools like a medication evaluation reduce the risk of your medicine hurting you and increase the prescription's effectiveness for your treatment.

It may come as a surprise to learn that prescription drugs are the fourth leading cause of death in the US. Annually, serious side effects of properly prescribed drugs cause about 128,000 deaths.1 Even with proper prescriptions, medicines contribute to 1.9 million hospitalizations each year.1

The-Annual-Cost-of-Medication-Errors

A substantial portion of death occurs due to medication errors. They cause 7,000 to 9,000 deaths and cost the US economy over $40 billion each year.2 Ordering errors account for about half of all medication errors. The most common ordering errors are:

Wrong prescription

Wrong dose or method of use

Wrong frequency of drug use

Drug-related errors also cause patient dissatisfaction, poor treatment outcomes, and decreased trust in the healthcare system. Learn how comprehensive diagnostic evaluations at J. Flowers Health Institute improve patient outcomes.

What is Medication Evaluation?

Medication evaluation or medication-use evaluation (MUE) is a quality assurance (QA) tool. It reviews a patient's prescription and medication against a set of standards.

A multidisciplinary team, comprising physicians, pharmacists, nurses, and administrators, prepares these standards.

Hospitals and health care facilities use MUE to assess and improve the use of drugs. It aims to achieve optimal treatment outcomes with the safe and effective use of medicines.

Medication evaluation is a continuous activity. The review begins before a drug is dispensed, and continues during and after dispensing. A continuous review is crucial to identifying and resolving drug-related problems.

A health facility may use medication evaluation criteria to assess and monitor:

Medication or a class of similar drugs

Disease state or condition

A medication-use process, which includes prescribing, preparing, dispensing, and administering

Example of Medication Evaluation Saving a Life

Health professionals from different specialties may use MUE when treating a person with multiple health issues. Look at the example below.

Mr. A is using a drug to thin his blood to prevent a stroke. He is diagnosed with arthritis (chronic joint pain). Thus, he receives a prescription for pain medication from another prescriber.

Using these drugs together can cause potentially fatal internal bleeding. Here, the collaboration between the two prescribers is crucial to preventing life-threatening bleeding.

What are the Types of Medication Evaluation?

There are three types of medication evaluation. They are:3

Prospective MUE

It involves the review of a patient’s medications before dispensing. Prospective evaluation checks if a drug is suitable for the patient’s condition. It also determines:

Doses

Formulation of the drug and method of use

Duration of therapy

Expected outcomes

Potential side effects

Cost of therapy

Quantity to be dispensed

Interactions that may occur when used together with other drugs

Conditions or diseases when the drug should not be used

Concurrent MUE

The review is done during drug therapy. If any issues surface during the concurrent review, your doctor may stop or switch your medication.

For example, a doctor may change the dose of an antibiotic based on the results of lab testing. If your condition does not respond to the prescribed drug, they may switch to another antibiotic of the same or another class.

Concurrent MUE helps resolve issues, such as:

Drug-disease interactions

Drug-drug interactions

The need to change the dose or the drug

Special precautions in conditions such as pregnancy or elderly patients

Retrospective MUE

The review is done after the patient has received drug therapy. It assesses:

The cost to a patient

Severe side effects

Drug interactions

Differences in prescribing (for the same condition) between doctors

Are Medication Evaluation and Drug Evaluation the Same?

Medication evaluation, drug use evaluation, and drug utilization review are used interchangeably. There are some differences between these terms. That said, all of them aim to ensure the safe and effective use of medicines.4 Most notably, MUE focuses on improving treatment outcomes and the quality of life of a patient.

What are the Goals of Medication Evaluation?

The goals and objectives of medication evaluation include:5

12-Percent-of-Older-People-Visiting-the-ER-Receive-Inappropriately-Prescribed-Medicines

Promoting optimal treatment outcomes with the prescribed medications. 12 in 100 older people visiting the emergency department receive inappropriately prescribed medicines.6

Reducing the risk of drug-related problems, such as severe side effects and increased risk of toxicity

Checking if the medications you receive are effective

Promoting patient safety

Lowering the cost of drug therapy and drug wastage

For Healthcare Professionals

Identifying the best course of medication - right doses, right frequency, and right method of use

Establishing standards for medication-use processes

Evaluating how new drugs can improve treatment outcomes and reduce cost

Reducing medication error. According to AARP, medication-related errors more than doubled from 3,065 in 2000 to 6,855 in 2012. Most errors are associated with drugs to treat diabetes, heart disease, and pain.7

Establishing a consensus on medication use among members of a multidisciplinary team

Complying with governmental or professional standards

How are Medicines for Evaluation Selected?

The American Society of Health-System Pharmacists Criteria

Several factors determine whether a drug or drug-use process should be evaluated. The American Society of Health-System Pharmacists has given a list of criteria for selecting a drug for evaluation.

A drug can be considered for the evaluation if it:

Causes severe side effects at the prescribed doses, such as anticancer drugs

Alters the effects of another medication, such as non-narcotic pain drugs, and antibiotics

Affects the results of a diagnostic procedure, such as cephalosporins

Is used in people who are more likely to experience severe side effects

Is frequently used in a large number of people, such as Vicodin (hydrocodone/acetaminophen)

Is expensive

Can cause toxic effects at usual doses

World Health Organization Criteria

According to the WHO, the candidates for medication evaluation include the following:8

Drugs with a Narrow Therapeutic Index (TI)

TI is a value that shows the difference between toxic and effective doses of a drug. A medicine with a lower value of TI can cause toxicity even with a small increase in the dose. Thus, a person using the drug should be closely monitored.

Examples of drugs with narrow TI are:

  • Cyclosporine (Sandimmune)
  • Carbamazepine (Tegretol)
  • Digoxin (Digox)
  • Flecainide (Tambocor)
  • Lithium (Lithobid)
  • Phenytoin (Dilantin)
  • Rifampicin (Rifadin)
  • Theophylline (Elixophyllin)
  • Warfarin (Coumadin)

Teratogenic Drugs

These drugs can affect the development of the fetus or cause congenital disabilities. Examples of teratogenic medicines include:

  • Captopril (Capoten)
  • Isotretinoin (Accutane)
  • Tetracycline (Achromycin)
  • Warfarin (Coumadin)
  • Phenytoin (Dilantin)
  • Lithium (Lithobid)
  • Methotrexate (Rheumatrex)

Carcinogenic Drugs

These drugs can cause cancer. Examples of carcinogenic drugs are:9

  • Azathioprine (Imuran)
  • Estrogen-progestogen menopausal therapy
  • Tamoxifen (Nolvadex)
  • Cyclophosphamide (Cytoxan)
  • Melphalan (Alkeran)

Drugs With High Abuse Potential

These drugs can cause severe physiological or psychological dependence. Examples include:

  • Hydromorphone (Dilaudid)
  • Meperidine (Demerol)
  • Oxycodone (OxyContin)
  • Fentanyl (Fentora)

Other Drugs That Can Benefit From a Medication Evaluation

Antibiotics

The main goal of evaluating antibiotics is to prevent antimicrobial resistance. Antimicrobial resistance is one of the biggest global health challenges. Treatment-resistant microbes cause over 35,000 deaths each year in the US, reports the CDC.10

Over the years, microbes have become resistant to many antibiotics, including:

Penicillin

Cephalosporin

Azithromycin (Zithromax)

Imipenem (Primaxin)

Fluconazole (Diflucan)

Ciprofloxcin (Cipro)

Daptomycin (Cubicin)

Psychotropic Drugs

Psychotropic drugs can alter your perception, feelings, emotions, and behavior. These medicines are used to treat depression, mania, anxiety, psychosis, and sleep problems.

Hospitals have medication evaluation programs for all major classes of psychotropic medicines.11

These include:

Antipsychotics - Olanzapine (Zyprexa), quetiapine (Seroquel)

Antidepressants - Citalopram (Celexa), Fluoxetine (Prozac)

Antianxiety drugs - Escitalopram (Lexapro), Duloxetine (Cymbalta)

Hypnotic agents (sleeping pills) - Ambien (zolpidem), Lunesta (eszopiclone)

Drugs for bipolar disorder - Lithium (Lithobid)

Antiparkinsonian drugs - Rasagiline (Azilect), Carbidopa and levodopa (Parcopa)

Cancer Drugs

Anticancer drugs not only kill cancer cells but also damage healthy cells. Thus, it is critically important to evaluate these drugs to prevent severe side effects.

Some common anticancer drugs that need medication evaluation are:

Cisplatin (Platinol)

Paclitaxel (Taxol)

Pegfilgrastim (Neulasta)

Nivolumab (Opdivo)

Abiraterone (Zytiga)

Rituximab (Rituxan)

Bevacizumab (Avastin)

Narcotic Pain Medications

Narcotic (opioid) painkillers are used to treat moderate-to-severe pain. These drugs carry a high risk of abuse and addiction. Thus, evaluation should be done before, during, and after opioid therapy. Examples of commonly used narcotic pain drugs are:

Fentanyl (Fentora)

Hydrocodone (Vicodin)

Hydromorphone (Dilaudid)

Tramadol (Ultram)

Morphine (Roxanol)

Meperidine (Demerol)

Cardiovascular Drugs

Cardiovascular drugs treat disorders of the heart and blood vessels. They are used in people with high blood pressure, abnormal heart rhythms, or high blood cholesterol. Besides, some drugs are also used to prevent blood clots.

Examples of drugs in this class are:

Captopril (Capoten)

Warfarin (Coumadin)

Atorvastatin (Lipitor)

Amiodarone (Cordarone)

Propafenone (Rythmol)

Immunosuppressants

These drugs suppress the body's immune system. They are commonly used to prevent your body from rejecting a transplanted organ.

Because they tend to cause severe side effects, a close evaluation is essential during the course of therapy. Examples of immunosuppressive drugs are:

Cyclosporine (Sandimmune)

Mycophenolate Mofetil (Cellcept)

Sirolimus (Rapamune)

Azathioprine (Imuran)

Medication Evaluations for Specific Diseases

Some drugs used to treat specific diseases have narrow TI. Besides, some tend to cause severe side effects. In such cases, medication evaluation helps reduce the risk of complications.

Examples include drugs to treat:

Abnormal heart rhythm, such as phenytoin. Phenytoin is also used to control seizures in epileptic patients.

Bipolar disorder, such as lithium

Heart failure, such as digoxin

Breathing difficulties and wheezing, such as theophylline

Medication Evaluation Related to a Clinical Event

Clinical events, especially those involving the heart and brain, warrant emergency medical care. Close monitoring and evaluation are essential to ensure proper drug use and positive outcomes. Some frequent clinical events in the US are:

Acute Myocardial Infarction (AMI)

AMI or heart attack is a potentially fatal condition. It occurs when there is a sudden blockage in the blood vessels that supply to the heart muscles. As a result, the tissues in the heart muscles die. Surgery and medications are two ways to treat AMI.

Drugs to treat AMI include:

  • Alteplase (Activase)
  • Warfarin (Coumadin)
  • Captopril (Capoten)
  • Atenolol (Tenormin)

Stroke

A stroke occurs when the brain cells do not get enough oxygen due to limited blood flow to the brain. It can cause paralysis, memory problems, and behavioral changes. Medications used to treat a stroke are:

  • Clopidogrel (Plavix)
  • Warfarin (Coumadin)
  • Apixaban (Eliquis)

Unstable Angina

When you have unstable angina, your heart does not get enough oxygen. Sometimes, it can lead to a heart attack. Drugs used to treat the condition are:

  • Clopidogrel (Plavix)
  • Warfarin (Coumadin)
  • Atorvastatin (Lipitor)
  • Esmolol (Brevibloc)
  • Heparin
  • Lepirudin (Refludan)

How Does Medication Evaluation Work?

Medication evaluation works differently depending on the hospital and the type of population under study. Nonetheless, the following steps are common to almost all the evaluation programs.

  1. Establish authority for planning, monitoring, and supervising the MUE process. It is done by the Drug and Therapeutics Committee (DTC). The DTC also selects the drug or drug-use processes that need evaluations.
  2. Set objectives for the evaluation process.
  3. Identify and establish the criteria for drug selection. The criteria usually include a drug's uses, doses, preparations, method of use, and patient education.
  4. Collect data about the drug or drug-use processes. The data may be collected before, during, or after dispensing.
  5. Analyze the data and prepare a report. The report should clearly show if a drug meets the predetermined criteria.
  6. Provide feedback to the prescribers.
  7. Prepare a plan of action to improve patient outcomes.
  8. Regularly assess the evaluation process. It helps to identify if the MUE program needs changes or can be continued as it is. If the evaluation fails to bring expected results, the DTC may decide to stop the program.

The Workflow Process of Medication Evaluation

The medication evaluation team typically comprises nurses, pharmacists, and doctors.

Nurses. They collect medical data of patients being studied. Besides, they check the patients' medications.
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Pharmacists. They check if the medications are appropriately prescribed. They also review dosages, frequency/duration of intake, and the risk of side effects and interactions.

⬇
Doctors. All the members decide if any changes are needed in drug therapy. If necessary, a doctor may change the prescription.

⬇
Follow-up actions. These actions are based on the findings of the evaluation process. Examples include changes in the monitoring process. The information may be shared via newsletters or in seminars (sometimes outside the hospital).

How an In-House Multidisciplinary Team Improves the Medication Evaluation Process

A medication evaluation process succeeds in meeting its goals only when all the team members work together. Having an in-house multidisciplinary team allows the members to communicate, consult, and understand their roles in the process. That way, the approach avoids the most common pitfalls of medication evaluation.

Sets a Clear Authority in Charge of the Overall Process

Sometimes, a lack of authority prevents an MUE process from working smoothly. When the authoritative body does not recognize the process, it may become ineffective. Besides, a lack of recognition may also cause the suboptimal performance of the process. Most notably, the involvement of medical staff is critical to the success of an evaluation.

Improves Organization of the Evaluation

Members of the team should understand their role in the process. Thus, the authoritative body should clearly define the roles and assign the tasks accordingly. Failure to do so not only creates confusion but may also keep the process from achieving its desired goals.

Improves Communication Between the Team Members

Effective communication among all the team members is key to the success of a medication evaluation. The pharmacist should communicate the criteria for medication use to all professionals before starting the evaluation process. Likewise, they should also play a central role in managing the processes involved in the evaluation.

Improves Documentation of the Process

All quality assurance tools have one common thing to follow. It is "do what you write, and write what you do." Without proper documentation, key activities in the evaluation may be missed. Documentation in an MUE process includes the summaries of the following:

  • Prescription of each prescriber
  • Findings of the evaluation
  • Conclusions
  • Recommendations
  • Follow-up actions

Improves Involvement of the Entire Team

A medication evaluation process demands the active participation of each team member. Each professional should be consulted while developing the criteria for medication use. Likewise, the finding should be conveyed to all the members.

Improves Follow-Through

MUE is not a one-time study. It is a continuous and dynamic process. Thus, each activity in the process should be carefully assessed and revised if necessary.