Transcript No Slide Title

Pethidine prescribing in the ED… Let’s be rational!
Kaye KI, Maxwell DJ, Graudins L, on behalf of the the NSW Therapeutic Assessment Group (NSW TAG)
Drug Use Evaluation (DUE) Support Group, PO Box 766 Darlinghurst NSW 2010
INTRODUCTION
METHODS
OBJECTIVE
Pain management is an ongoing area of interest for NSW TAG.
In 1998 NSW TAG produced guidelines for rational use of
opioids for GPs Prescribing for Pain in Migraine and Low Back
Pain. These are currently being revised and updated. NSW TAG
has also produced guidance documents on the use of newer
analgesics in hospitals, including COX-2 inhibitors and
tramadol. These documents can be downloaded from the NSW
TAG web site.
Pain management in hospital emergency departments (EDs) is a
topical issue. The ongoing use of pethidine in EDs is of concern.
Despite its limitations (Figure 1), pethidine is still widely used in
hospitals. A recent survey of 18 NSW hospitals showed that a
significant proportion of pethidine prescribing occurred in
Emergency Department (Table 1)
To increase awareness of the
appropriate place for pethidine in pain
management and to optimise pethidine
prescribing by implementing a simple,
ongoing DUE process in hospital EDs.
15 hospitals in the TAG network are participating. DUE
methodology will be used to facilitate data collection, evaluation
of data against agreed standards, feedback of evaluated data
and targeted intervention. Over a 12-month period, multiple
DUE cycles will be implemented in each participating hospital,
the first scheduled for January 2003.
A steering committee has been convened to provide advice for
development of feedback reports, educational materials and
mechanisms for on-going sustainability of the program.
Each hospital has nominated a project coordinator who is
responsible for liaison with ED staff and hospital committees.
They are also coordinating data collection and feedback
programs in their hospital. NSW TAG will provide information
and support to hospital coordinators to facilitate these
processes.
Hospital Pethidine units Pethidine units Percentage
issued to ED
issued overall
ED/total
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
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%
Table 1
Pethidine usage TAG/TAGNet hospitals July-Sept 2001
FURTHER INFORMATION
For further information about the
Pethidine in ED Project contact the
NSW Therapeutic Assessment Group
Email: [email protected]
Phone: 02 8382 2852
This study is funded by a
grant from the National
Institute for Clinical Studies
Hospital coordinators will record the number of patients
receiving pethidine in the ED (from existing Schedule 8 drug
registers) and indications for that use. Stock issues from
pharmacy for a range of analgesics will also be recorded.
A feedback summary will be prepared by each hospital
coordinator using a format prepared by NSW TAG. Prescribing
patterns will be compared with evidence-based guidelines and
areas of non-concordance highlighted. Feedback will be
distributed to the ED Director, individual prescribers and the
hospital Drug Committee. Targeted educational interventions
will be introduced to promote rational prescribing.
THE PROBLEM WITH PETHIDINE
[i]
Pethidine has a shorter duration of action than morphine
with no additional analgesic benefit
Pethidine has just as many side-effects as morphine
(including bronchospasm and increased biliary pressure)
Pethidine is metabolised to norpethidine, which has
potential toxic effects (eg convulsions), especially in
patients with renal dysfunction,
Pethidine is associated with potentially serious
interactions
in combination with other drugs.
Because of its euphoric effects:
Pethidine is the drug most commonly requested by
patients seeking opioids, and
Pethidine is the drug most commonly abused by health
professionals.
[i] National Health and Medical Research Council. Acute pain management:
scientific evidence, Commonwealth of Australia, 1999
www.nicsl.com.au
Figure 1
NSW TAG is an initiative of NSW clinical pharmacologists and pharmacists, funded by the NSW Health Department.
For more information about the NSW TAG network, visit our web site at www.nswtag.org.au.