Improving Analgesia in Emergency Departments: Optimising Use of Pethidine

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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

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Is there a problem?

• We know
• Australias consumption of pethidine ranks
  higher than other countries (Berbatis et
  al, MJA 2000524-527)
• Prescribing of pethidine by GPs is of concern
  to NSW Health ? TAG pain guidelines for migraine,
  low back pain and other chronic or recurrent
  non-malignant pain (revised 2002)
• What about prescribing of pethidine in Emergency
  Departments?

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Practice
Pethidine prescribing in NSW hospitals
JulySeptember 2001
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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
  professionals
• 1 National Health and Medical Research Council.
  Acute pain management scientific evidence,
  Commonwealth of Australia, 1999

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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
  evidence-based guidelines
• Identify and implement interventions to close the
  gap between evidence and practice
• Collaborate and share experience to help spread
  practice improvement

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The DUE Cycle

Act Plan Study Do
Implementing best practice
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Clinical Reference Committee
A/Prof Milton Cohen - Pain Physician,
Darlinghurst Pain Clinic Dr Jan Davies -
Project Officer, NICS Prof Ric Day - Clinical
Pharmacologist, SVH / NSWTAG Mr Stuart Dorkin -
ED Nurse, Westmead Hospital Dr Robert Dowsett -
Emergency Physician, Westmead Hospital Ms Kanan
Gandecha - Pharmaceutical Services, NSW
Health Dr Andis Graudins - Emergency Physician,
Westmead Hospital Ms Karen Kaye - Executive
Officer, NSW TAG Ms Margaret Knight -
Consumer Ms Kathleen Ryan - Quality Manager, St
Vincents Hospital Ms Susie Welch - ED
Pharmacist, Project Officer, NSW TAG Dr Alex
Wodak - Alcohol and Drug Specialist SVH
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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
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Data collection forms

• Pharmacy stock distribution reports

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Data collection forms

• ED prescribing

Please provide as much detail as possible about
indication for use
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Feedback reports
Plus commentary
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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