Improving Analgesia in Emergency Departments: Optimising Use of Pethidine

1
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

2
Workshop Outline

• 2.00pm Welcome
• 2.00pm Background and project overview
• Ms Karen Kaye, Executive Officer, NSW TAG
• 2.20pm The gap between evidence and practice
• Prof Ric Day, NSW TAG Project Team
• 2.40pm Rational use of opioids
• Panel discussion of case studies
• 3.10pm Afternoon tea
• 3.30pm Effective ways to change practice
• Ms Judith Mackson, Prescribing Program
  Co-ordinator, NPS
• 3.50pm DUE theory and practice - project
  implementation
• Ms Karen Kaye, NSW TAG
• 5.00pm Close

3
Background

• Is there a problem?
• Prescribing of pethidine in general practice
• Prescribing audit in hospitals 2001
• Influence of hospital prescribers
• Continuity of care

4
Aims of the Project

• Reduce prescribing of pethidine by 50 in each
  DUE cycle
• Conduct 3 DUE cycles during the 12 month project
• Set up a sustainable process of review of
  pethidine prescribing

5
The DUE Cycle

6
The Approach

• Use drug use evaluation to improve practice
• Audit prescribing of pethidine in a range of
  Emergency Departments
• Compare prescribing with recognised
  evidence-based guidelines
• Identify and implement interventions to close the
  gap between evidence and practice
• Collaborate and share experience to help spread
  practice improvement

7
Project Reporting Structure
NSW Therapeutic Assessment Group Reports to
National Institute for Clinical Studies
DUE Support Group
Pethidine in ED Project Group (hospital
co-ordinators)
Clinical Reference Committee
Hospital teams and committees
Project team
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Clinical Reference Committee
Prof Ric Day - Clinical Pharmacologist, SVH /
NSWTAG Dr Andis Graudins - Emergency Physician,
Westmead A/Prof Milton Cohen - Pain Physician,
Darlinghurst Pain Clinic Dr Alex Wodak -
Alcohol and Drug Specialist SVH Dr Robert Dowsett
- Emergency Physician, Westmead Ms Kanan
Gandecha - Pharmaceutical Services, NSW
Health Ms Margaret Knight - Consumer Mr Stuart
Dorkin - ED Nurse, Westmead Hospital Ms Kathleen
Ryan - Quality Manager, St Vincents Hospital Dr
Amanda Alexander - Project Officer, NICS Ms
Susie Welch - ED Pharmacist, Project Officer,
NSW TAG Ms Karen Kaye - Executive Officer, NSW
TAG
9
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
10
The process to date

• Hospital project co-ordinators nominated
• Institutional approval
• Liaison with hospital teams
• Co-ordination of data collection and feedback
• Co-ordination of education / interventions
• Reporting back to hospital committees CEO
• Pragmatic approach minimal data collection
• Data collection form prepared
• Data collection process piloted (3 sites)

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Workshop Goals

• Provide a forum for hospital coordinators and
  team members to meet
• Clarify goals, objectives and project plan
• Encourage input and feedback from teams
• Clarify support requirements
• Discuss issues of concern