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 Pethidine in ED Project Group (hospital co-ordinators) DUE Support Group NSW Therapeutic Assessment Group Reports to National Institute for Clinical Studies Hospital teams and committees Clinical Reference Committee Project team

8. 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 HospitalMurwillumbah Hospital Bankstown HospitalPrince of Wales Hospital Blacktown HospitalRoyal North Shore Hospital Mt Druitt HospitalRoyal Prince Alfred Hospital Grafton Base HospitalSouthern Area Health Service John Hunter HospitalSydney / Sydney Eye Hospital Lismore Base HospitalWestmead Hospital Mullumbimby HospitalWollongong 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)

11. 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