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Improving Analgesia in Emergency Departments: Optimising Use of Pethidine

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. Is there a problem?. We know:

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Improving Analgesia in Emergency Departments: Optimising Use of Pethidine

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  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. Is there a problem? We know: • Australia’s consumption of pethidine ranks higher than other countries (Berbatis et al, MJA 2000;524-527) • 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?

  3. Practice Pethidine prescribing in NSW hospitals: July–September 2001

  4. 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

  5. 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

  6. The DUE Cycle Act Plan Study Do Implementing best practice

  7. 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

  8. 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

  9. Data collection forms Pharmacy stock distribution reports

  10. Data collection forms ED prescribing Please provide as much detail as possible about indication for use

  11. Feedback reports Plus commentary

  12. 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:

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