title: Pethidine in emergency departments: promoting evidence-based prescribing.
abstract: OBJECTIVE
  To reduce pethidine prescribing in hospital emergency departments (EDs).
  
  
  METHODS
  Multi-centre drug use evaluation (DUE) process.
  
  
  METHODS
  Emergency departments in 23 public hospitals (22 in New South Wales, 1 in Victoria) from 1 September 2002 to 31 August 2003. Participating hospitals included seven principal referral hospitals, six major non-teaching hospitals and 10 district or community hospitals. Data for comparison were collected from 12 non-participating hospitals.
  
  
  METHODS
  Hospital coordinators at each participating hospital were provided with support to implement a range of prescribing interventions in their ED in each of three DUE cycles. Interventions included educational materials (guidelines, posters, prescribing reminders), audit and feedback, and small-group discussions. Three audits of pethidine prescribing were undertaken. Prescribing was compared with evidence-based guidelines and non-concordance identified.
  
  
  METHODS
  Number of dosage units of parenteral analgesics issued to the ED from each hospital's pharmacy department was recorded monthly and aggregated in 3-month periods.
  
  
  RESULTS
  In the 12 months between the preintervention period and the equivalent post-intervention period, pethidine use decreased by 62% in project hospitals (4669 to 1793 units) and 56% in control hospitals (1476 to 648 units). Six months after project completion there was a significantly greater reduction from baseline in participating hospitals (71%; 4669 to 1348 units) compared with non-participating hospitals (64%; 1476 to 532 units; P < 0.001). There was a concurrent increase in use of both morphine and tramadol.
  
  
  CONCLUSIONS
  There was a sustained reduction in pethidine use during the study period, which may indicate successful promotion of safer analgesic prescribing. It is not clear whether changes were a result of collaborative DUE methods or other factors.
authors.affiliation: NSW Therapeutic Advisory Group Inc, PO Box 766, Darlinghurst, Sydney, NSW 2010. nswtag@stvincents.com.au
authors.forename: Karen I
authors.initials: KI
authors.lastname: Kaye
authors.forename: Susan A
authors.initials: SA
authors.lastname: Welch
authors.forename: Linda V
authors.initials: LV
authors.lastname: Graudins
authors.forename: Andis
authors.initials: A
authors.lastname: Graudins
authors.forename: Tai
authors.initials: T
authors.lastname: Rotem
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Davis
authors.forename: Richard O
authors.initials: RO
authors.lastname: Day
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008614:Meperidine / Q000627:therapeutic use*; D009517:New South Wales; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014739:Victoria
chemical_list: D000701:Analgesics, Opioid; D008614:Meperidine