Transcript Calvary Centre for Palliative Care Research The EMK

Calvary Centre for
Palliative Care Research
The use of an emergency
medication kit (EMK) in
palliative care community
practice.– The EMK Study
Dr Tracey Bullen*, Kate Maher, Dr John Rosenberg,
Brad Smith
[email protected]
Clare Holland House, 5 Menindee Dr, BARTON, A.C.T
Calvary Centre for
Palliative Care Research
The EMK Project.
Project aims
 To determine if the provision of emergency medication packs in
the patient’s home reduces preventable inpatient admission and
unscheduled emergency home visits.
 To evaluate the impact of EMKs upon caregiver self efficacy.
 To conduct a nation wide survey of the prevalence of EMK
usage .
Calvary Centre for
Palliative Care Research
The EMK Project.
Method
 Caregiver/patient dyads were provided with an emergency
medication kit and a medication diary to be used for educational
purposes.
 The EMK contained medications that addressed common
emergent symptoms.
 Caregivers completed a customised questionnaire about
medication management at admission, 3mths and 6mths to assess
perceptions of self efficacy.
Calvary Centre for
Palliative Care Research
The EMK Project.
Prevalence survey aims
 To assess the prevalence of the use of emergency medication
kits in community palliative care practice nationally.
 The survey contained up to 15 items depending upon the
responses provided exploring medication management and
needs across services.
Calvary Centre for
Palliative Care Research
The EMK Project.
Preliminary Analysis
Patient data
 Report the frequency of outcomes based on the audit form when
the kits are accessed.
Questionnaire analysis
 A correlation analysis will be conducted with all the self efficacy
questionnaire items 1-12 to identify which items appear to be
measuring the same constructs.
 Descriptive factor analysis will be conducted with items 1-12 which
look at feelings about medication management and perceived
capability in managing medication.
 A paired samples t test to look at individual differences across
variables of self efficacy scores, over time if appropriate will be
performed.
Calvary Centre for
Palliative Care Research
The EMK Project.
Patient preliminary results
 100% recruitment rate of eligible dyads
 28/58 patients recruited to date have died.
 18/21 patients whose preferred place of death (PPOD) was at
home died at home to date. 23/28 patients died in their known
PPOD.
 No patients have died in hospital
 The EMK has been accessed on 23 occasions.
 Median time of kit access after admission was 10 days.
 Data suggests in over 90% of cases accessing the kit averted an
acute admission to hospital or hospice.
Calvary Centre for
Palliative Care Research
The EMK Project.
Caregiver results
 Professional opinion of the clinical staff reported the presence of
the EMK had a positive impact upon caregiver confidence in 83%
of cases (20/24).
 Average age of caregivers 60.7yrs (SD=14.2, range = 28 – 89).
 The majority of caregivers were female (66%) of their spouses
(59%).
 Average baseline scores for each item suggest an average score
of 6.95 (SD=2.07 range = 0 – 10).
 Preliminary correlations indicate that all items appear to
significantly correlate with each other.
Calvary Centre for
Palliative Care Research
The EMK Project.
Prevalence survey results
 28% (50/179) of invitees completed the survey. We received
completed surveys from NSW, QLD, VIC (majority), SA and NT.
 57% of respondents reported that their service did not use EM
kits (25/48). Of these respondents 64% (16) stated the process
did not meet patient needs or required improvement.
 88% (22/25) stated that an EMK could improve patient
outcomes. 67% (16/24) of respondents reporting needing to
“chase parenterals” after a patient was admitted to the service
more than once per month
Calvary Centre for
Palliative Care Research
The EMK Project.
What is working well/not so
well?
What worked well/is working well
 CNC screening for eligible patients (55% of all patients met
eligibility criteria)
 100% recruitment participation rate of eligible patient/carer
dyads
What didn’t work well/isn’t working well
 Strict supervision of the recruitment process is required to
ensure consent forms are returned in a timely fashion.
 Completion of audit forms has not been consistent when kits are
accessed since the launch of a new electronic system
Calvary Centre for
Palliative Care Research
The EMK Project.
Future directions
 Recruiting sites where this approach to medication management
is not currently occurring.
 Further validation of the caregiver questionnaire i.e. concurrent
validity with other self efficacy scales e.g. the revised scale for
care-giving self efficacy .
 Ideally conducting this trial across multiple sites where the
community patient profile differs would strengthen the evidence
base for this practice change.
Calvary Centre for
Palliative Care Research
The EMK Project.
 Any questions or feedback on
this project would be appreciated