Transcript NSW TAG Pethidine in ED Project

NSW TAG
Pethidine in ED Project
Interim
Aggregate Results
Supported by the National Institute of Clinical Studies
Australia's national agency for closing the gaps between
evidence and practice in health care.
Project Workshop
August 2003
How did we do?
Goal:
50% reduction in pethidine use with each
audit cycle
Remember:
• Audit Cycle 1 began Jan 03
• Audit Cycle 2 began Apr 03
• Audit Cycle 3 began July 03
Pethidine issues to ED
Number of units
Pethidine issues to ED
All hospitals
2000
1800
1600
1400
1200
1000
800
600
400
200
0
Total All
Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun02
02
02
02
03
03
03
03
03
03
A = Principal referral
B = Major non-teaching
C = District
Pethidine issues to ED
D = Community
Pethidine issues to ED
by Peer Grouping
900
Number of Units
800
700
600
Total A
500
Total B
400
Total CD
300
200
100
0
Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun02
02
02
02
03
03
03
03
03
03
Pethidine issues to hospital
(excluding ED)
Number of units
Pethidine Issues (All hospitals)
8000
7000
6000
5000
4000
3000
2000
1000
0
EDs
Rest of
hosp
Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun02 02 02 02 03 03 03 03 03 03
Pethidine issues to hospital
(excluding ED)
Pethidine Issues by Peer Grouping
4000
Number of issues
3500
ED (A)
3000
Rest (A)
2500
ED (B)
2000
Rest (B)
ED (CD)
1500
Rest (CD)
1000
500
0
Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun02
02
02 02
03 03
03 03
03
03
Morphine issues to ED
Morphine issues to ED
All hospitals
7000
Number of units
6000
5000
4000
Total All
3000
2000
1000
0
Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun02
02
02
02
03
03
03
03
03
03
Morphine issues to ED
Morphine issues to ED
by Peer Grouping
4500
Number of units
4000
3500
3000
Total A
2500
Total B
2000
Total CD
1500
1000
500
0
Sep02
Oct02
Nov- Dec02
02
Jan03
Feb03
Mar03
Apr03
May03
Jun03
Tramadol issues to ED
Number of units
Tramadol issues to ED
All hospitals
1000
800
600
Total All
400
200
0
Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun02
02
02
02
03
03
03
03
03
03
Tramadol issues to ED
Number of units
Tramadol issues to ED
by Peer Grouping
600
500
400
300
200
100
0
Total A
Total B
Total CD
Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun02 02 02 02 03 03 03 03 03 03
Ketorolac issues to ED
Ketorolac issues to ED
All hospitals
Number of units
1000
800
600
Total All
400
200
0
Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun02 02 02 02 03 03 03 03 03 03
Ketorolac issues to ED
Number of units
Ketorolac issues to ED
by Peer Grouping
600
500
400
300
200
100
0
Total A
Total B
Total CD
Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun02 02 02 02 03 03 03 03
03 03
Fentanyl issues to ED
Fentanyl issues to ED
All hospitals
Number of units
1000
800
600
Total All
400
200
0
Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun02 02 02 02 03 03 03 03 03 03
Fentanyl issues to ED
Fentanyl issues to ED
by Peer Grouping
Number of units
600
500
400
Total A
300
Total B
200
Total CD
100
0
Sep02
Oct02
Nov- Dec02
02
Jan03
Feb03
Mar03
Apr03
May03
Jun03
Pethidine as a proportion of all parenteral
analgesia in ED
All hospitals
Number of units
16000
12000
All analgesics
8000
Pethidine
4000
0
Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun02 02 02 02 03 03 03 03 03 03
Pethidine as a proportion of all parenteral
analgesia in ED
5000
4000
3000
2000
1000
0
A - All analgesics
Jun-03
May-03
Apr-03
Mar-03
Feb-03
Jan-03
Dec-02
Nov-02
Oct-02
A - Pethidine
Sep-02
Number of units
A Group Hospitals
Pethidine as a proportion of all parenteral
analgesia in ED
10000
8000
6000
B - All analgesics
4000
B - Pethidine
2000
Jun-03
May-03
Apr-03
Mar-03
Feb-03
Jan-03
Dec-02
Nov-02
Oct-02
0
Sep-02
Number of units
B Group hospitals
Pethidine as a proportion of all parenteral
analgesia in ED
1200
1000
800
600
400
200
0
CD - All analgesics
Jun-03
May-03
Apr-03
Mar-03
Feb-03
Jan-03
Dec-02
Nov-02
Oct-02
CD - Pethidine
Sep-02
Number of units
CD Group hospitals
Reduction in pethidine use:
Did we achieve our goal?
Pethidine units issued to ED – All hospitals
Oct / Nov / Dec Jan / Feb / Mar
5225
3207
Change in pethidine use
- 39%
Jan / Feb / Mar Apr / May / Jun
3207
2723
Change in pethidine use
- 15%
Overall (to date):
- 47%
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Number of episodes
Indications for pethidine use
Use of pethidine in EDs: Indications identified to date
90
80
70
60
50
Audit 1
40
Audit 2
30
Audit 3
20
10
0
Which teams are prescribing?
Proportion of ED Prescribing
Attributed to Medical / Surgical Teams
100%
80%
Audit 1
60%
Audit 2
40%
Audit 3
20%
0%
ED
Surg/Ortho
Other
Which prescribers?
Proportion of ED prescribing
Attributed to Prescribers
70%
60%
50%
40%
30%
20%
10%
0%
Audit 1
Audit 2
Audit 3
RMO
Reg
Spec
Nurse
GP/CMO