When developing a medication-use program, follow these tips
Follow research principles
Hospital pharmacists who would like to be driving force behind their organization's medication-use evaluation (MUE) program first should focus on selecting a topic that is both timely and relevant clinically, an expert advises.
"It's easy to identify these topics because they are the things you're faced with everyday," says Kim C. Coley, PharmD, FCCP, a professor at the University of Pittsburgh in Pittsburgh, PA.
These are issues that arise at formulary review committees, new drugs, safety issues, and similar items, Coley says.
"Also, you should think ahead because it's important that when you come up with your findings — no matter what they are — that these should be something that people at your institution want to hear about," Coley adds. "You have to anticipate that your findings will impact practice locally."
For example, a topic might be a drug that appears to have safety issues, such as adverse events that occur within a certain population. Hospital officials might desire to have a medication-use evaluation done to see what can be done to improve patient safety with regard to this medication, she explains.
"So there has to be an appropriate group that is interested in your findings," Coley adds.
Pharmacists generally are good at conducting projects like a medication-use evaluation because of their tendency to be cautious and attentive to details, Coley notes.
"They are careful with the drug dispensing process, checking and double-checking, and that's what makes a good researcher," she adds.
However, without following careful preparatory steps in conducting an MUE, pharmacists run the risk of starting a project that can never be completed, Coley says.
"Everybody always underestimates the time it takes," she adds. "Talk to people who've done this before."
Here are the steps pharmacists might take when developing a medication-use program:
1. Write a good research question. "One pitfall with practitioners is they sometimes don't ask specific questions," Coley notes. "They say, 'I'm going to look at this drug.'"
But they need to determine the research question through asking themselves these questions:
- Am I interested in dosing patterns?
- What is the drug's impact on patients?
- What are the typical and out-of-ordinary drug responses?
"You should have a specific research question, and if you're not specific, you'll find that you collect a lot of information and you won't know what to do with it," Coley says.
"The whole point is you should approach doing a medication use evaluation program like a research study," she explains.
"You use the same process that a researcher would use to develop a hypothesis of a study, including background research on a topic," Coley says.
For pharmacists who are going to attempt their first MUE, it might be wise to avoid writing a question involving drugs in the intensive care unit, Coley says.
"Start with something used in a general medicine population and focus on something where you can say what the outcome is that you want to measure," she suggests. "Make sure it's some outcome that's easy to extract."
2. Conduct a small pilot study. This can be as informal as observing a couple of patients who received the drug and determining the conflating factors, Coley says.
While conducting the pilot study, pharmacists should keep in mind that the goal is a simple data collection that clearly demonstrates a trend, she adds.
"Think about your patient population," she advises. "Are there other problems they're having that would impact your ability to measure what you are interested in measuring?"
Also, it's important to think about the time frame that will be studied.
"You can't just say, 'I'm going to look at drug X,'" Coley says. "Maybe you'll look only at one month's time frame if it's a common drug, or for an infrequent drug you might need months or years of data."
The pilot study might also highlight an issue that can arise with long-term studies, and that involves how medical practice changes over time.
Perhaps when the study is begun the drug is prescribed one particular way, but when the study's time frame ends, there could be a trend of a larger dose being given, Coley explains.
"This could mess things up for the study, depending on what your outcome is," she adds.
Coley personally tries to avoid doing MUEs that will require a lot of paper collection because she prefers the convenience of electronic data.
"But if you do something where you have to go to a chart and collect things on paper, then always pilot the form," Coley says. "Find a patient or two that might meet your criteria, and make sure your form is usable."
Pharmacists who don't pilot-test their data collection forms might find that there is no way they'll be able to collect all of the information they've included, she adds.
For example, if a pilot process shows that it takes two hours per patient to collect all the data needed in a paper format, then the pharmacist knows that it would be prohibitively time-consuming to study 200 paper charts, Coley explains.
3. Consider data access from the beginning. A major obstacle to completing an MUE involves access to data, Coley says.
"Collection of data is the biggest problem," she adds.
"One pitfall we find is people come up with a good question, but they don't think ahead about how they'll access the data to answer the question," Coley says.
"What data are available to look at it?" she says. "For instance, if you're doing a medication-use evaluation, and you're using electronic data from your hospital, and you need something recorded in a nursing note, but the nursing notes are still in paper form, then you can't collect that data."
So if some piece of the information isn't available, then the MUE won't be successful because you're missing an important piece of data, Coley says.
"You have to know what's available to you, and what the data points are and in what form it's available," she says.
For instance, a particular hospital might collect some data in a way that makes it difficult to retrieve the information.
"At this institution we have had a problem with getting blood pressure data because they're not stored in our electronic database that we have access to," Coley says. "That's changed because of the move toward electronic data, but it made it difficult 10 years ago."
If a pharmacist conducts an MUE with electronically recorded data, then it might be very clear which information is available, Coley notes.
"But whenever you get into collecting data on paper then that always takes much longer, so you have to do background research," she adds.
4. Seek collaborators with expertise. "I always recommend people seek collaborators with expertise in the areas where they're not strong," Coley says. "I almost never work in isolation."
So a pharmacist who is looking at an anti-inflammatory drug for inflammatory bowel disease might collaborate with a gastroenterologist, she suggests.
"If you're doing an MUE, and you have data points but are not good with data management, then find someone who can help you with that," Coley says. "There are people who have experience or knowledge in working with basic databases on everyone's computers."
5. Anticipate the data points. "Another thing that's very important is to write out all the data points you want to collect, including a mini-proposal," Coley says.
Written objectives for the MUE might include the following:
- Where will you collect the data?
- Which pieces of charts and precise data points will you collect?
- What are your primary outcomes of interest?
- Will your data points measure the outcomes you are interested in?
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