Pethidine prescribing in the ED Lets be rational

1
Pethidine prescribing in the ED Lets 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
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.
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)
INTRODUCTION
OBJECTIVE
METHODS
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 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 PETHIDINEi
• 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

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 nswtag_at_stvincents.com.au Phone 02
8382 2852

This study is funded by a grant from the National
Institute for Clinical Studies 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.