Medication use eVAluations at the VA

Yesterday was the first day of summer but my summer internship is more than half way over. My time at the VA has been going quickly. I recently started the biggest project of the summer. I am working on a medication use evaluation (MUE) with three pharmacists and a PGY1 resident. MUE’s are programs designed to improve the medication use process throughout the hospital. The evaluation consists of a review of the prescribing practices of dementia medications (cholinesterase inhibitors and memantine) within the Ann Arbor VA System. Dementia is a disorder characterized by major impairments in learning and memory. Clinically diagnosed dementia is often preceded by a period of gradual cognitive decline referred to as mild cognitive impairment (MCI). Cholinesterase inhibitors or memantine have not shown any benefit in the treatment of MCI. The MUE will verify that patients receiving cholinesterase inhibitors or memantine have a clinical diagnosis of dementia, not MCI. We are doing manual chart reviews of over 500 patients, with each review taking about 15 minutes. I won’t finish this summer but I look forward to hearing the results when the project is finished.

Besides the MUE I have also begun work on a project for the Chief of Dental Services. I am helping her create a presentation on the 25 most common drugs used in VA dental clinics. These include analgesics, antibiotics, local anesthetics, and sedatives. I am creating a handout with information on all of the drugs, including typical doses, indications, and clinical pearls surrounding their use.

Suffice it to say that I have plenty to do every day. The projects I work on have been teaching me a great deal about therapeutics and pharmacy practice in general. I look forward to seeing what comes next during my internship at the VA.