Transcript An Investigation of Hospital Prescribing of Proton Pump

Improving Analgesia in
Emergency Departments:
Optimising Use of Pethidine
A Multi-centre DUE Project
Coordinated by NSW Therapeutic Assessment Group
Funded by National Institute for Clinical Studies
Is there a problem?
We know:
 Australia’s consumption of pethidine ranks
higher than other countries (Berbatis et al, MJA 2000;524-527)
 Prescribing of pethidine by GPs is of concern to
NSW Health  TAG pain guidelines for migraine,
low back pain and other chronic or recurrent nonmalignant pain (revised 2002)
What about prescribing of pethidine in Emergency
Departments?
Hospital Pethidine units Pethidine units Percentage
issued to ED issued overall
ED/total
Practice
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
Average
950
0
121
140
3,304
290
340
460
400
640
255
502
370
137
105
115
200
389
Pethidine prescribing in NSW hospitals: July–September 2001
5,813
320
2,149
445
8,660
2,933
2,693
3,260
2,641
2,690
2,865
4,330
1,080
2,764
1,345
905
2,190
2,224
16.3%
0.0%
5.6%
31.5%
38.2%
10.0%
12.6%
14.0%
15.1%
24.0%
8.9%
11.6%
34.0%
5.0%
7.8%
12.7%
9.0%
17.5%
15.2%
Evidence
Why pethidine is not recommended1
Pethidine
 Has a shorter duration of action than morphine and no
additional
analgesic benefit
 Has similar side-effects, including increased biliary
pressure
 Is metabolised to norpethidine, which has potential toxic
effects
(eg convulsions) especially in patients with
renal dysfunction
 Is associated with potentially serious interactions in
combination with
other drugs (eg anti-depressants,
tramadol)
 Is the drug most commonly requested by patients
seeking opioids
 Is the drug most commonly abused by health
The Pethidine in ED Project
Using drug use evaluation to improve practice:



Audit prescribing of pethidine in a range of
Emergency Departments
Compare prescribing with recognised evidencebased guidelines
Identify and implement interventions to close
the gap between evidence and practice
Collaborate and share experience to help spread
practice improvement
The DUE Cycle
Act
Implementing best practice
Plan
Study Do
Clinical Reference Committee
A/Prof Milton Cohen
Dr Jan Davies
Prof Ric Day
Mr Stuart Dorkin
Dr Robert Dowsett
Ms Kanan Gandecha
Dr Andis Graudins
Ms Karen Kaye
Ms Margaret Knight
Ms Kathleen Ryan
Ms Susie Welch
Dr Alex Wodak
- Pain Physician, Darlinghurst Pain Clinic
- Project Officer, NICS
- Clinical Pharmacologist, SVH / NSWTAG
- ED Nurse, Westmead Hospital
- Emergency Physician, Westmead Hospital
- Pharmaceutical Services, NSW Health
- Emergency Physician, Westmead Hospital
- Executive Officer, NSW TAG
- Consumer
- Quality Manager, St Vincents Hospital
- ED Pharmacist, Project Officer, NSW TAG
- Alcohol and Drug Specialist SVH
Participating hospitals
Auburn Hospital
Murwillumbah Hospital
Bankstown Hospital
Prince of Wales Hospital
Blacktown Hospital
Royal North Shore Hospital
Mt Druitt Hospital
Royal Prince Alfred Hospital
Grafton Base Hospital
Southern Area Health Service
John Hunter Hospital
Sydney / Sydney Eye Hospital
Lismore Base Hospital
Westmead Hospital
Mullumbimby Hospital
Wollongong Hospital
Data collection forms
Pharmacy stock distribution reports
Data collection forms
ED prescribing
Please provide as much detail as possible about indication for use
Feedback reports
EXAMPLE OF FEEDBACK TO ED STAFF
Indication A Indication B Indication C
Intern
4
4
3
RMO1
5
2
1
RMO2
5
3
2
Reg
3
2
3
Staff specialist
2
3
4
6
5
4
3
2
1
0
Indication A
Indication B
sp
ec
ia
lis
t
Re
g
St
af
f
RM
O
2
Indication C
RM
O
1
In
te
rn
Number patients
prescribed pethidine
Pethidine prescribing by designation
De signation
Plus
commentary
When do we start?

First audit period starts:
20 January 2003

Feedback:
Available in February for review and discussion
by ED staff

For further information or clarification
contact: