Volume 184 - Issue 1
Pethidine in emergency departments: promoting evidence-based prescribing
Authors: Karen I Kaye, Susan A Welch, Linda V Graudins, Andis Graudins, Tai Rotem, Sharon R Davis and Richard O Day
Med J Aust 2006; 184 (1): 44-45. || doi: 10.5694/j.1326-5377.2006.tb00101.x
Published online: 2 January 2006
Published online: 2 January 2006
Karen I Kaye,* Susan A Welch,† Linda V Graudins,‡ Andis Graudins,§ Tai Rotem,¶ Sharon R Davis,** Richard O Day††
* Executive Officer, ** Research and Liaison Officer, NSW Therapeutic Advisory Group, PO Box 766, Darlinghurst, NSW 2010. † Senior Pharmacist, †† Director, Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, NSW. ‡ Medication Safety and Quality use of Medicines Pharmacist, Sydney Children's Hospital, Sydney, NSW. § Emergency Physician and Director, Clinical and Experimental Toxicology Unit, Prince of Wales Hospital, Sydney, NSW; and Senior Lecturer (Conjoint), University of New South Wales. ¶ Statistician, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW. nswtagATstvincents.com.au
In reply: As Mitra and Cameron point out, policy change can be effective in influencing prescribing practice. Indeed, use of a restrictive formulary is a strategy used by drug and therapeutics committees in most Australian hospitals. However, where support among clinicians for policy change is lacking, significant time and effort is required by those responsible for policy implementation. Confrontation and lack of interdisciplinary cooperation can be expected.
Quality use of medicines (QUM) means selecting management options wisely, choosing suitable medicines if a medicine is considered necessary, and using medicines safely and effectively. Australia is fortunate in having a National Medicines Policy1 and a national strategy for QUM.2 This strategy recognises the importance of active and respectful partnerships, and of consultative, collaborative, multidisciplinary activity to improve the quality use of medicines.
To attain QUM, “. . . key partners must be involved at all stages in designing, implementing and evaluating QUM programs . . . Multiple activities and strategies are needed to raise awareness about issues related to QUM. Attitudes, knowledge, skills and behaviours that support QUM need to be developed and maintained”.2
Our approach was based on these principles. Pielage provides another example of the successful use of this approach to limit pethidine prescribing in a large teaching hospital, which should be applauded.
Doctors, pharmacists, nurses and consumers are important partners in QUM. An educative, multidisciplinary approach that respects each partner is the most appropriate way to ensure sustained practice change and promote QUM in hospitals and the wider community.
References
- The National Medicines Policy Document. National Medicines Policy 2000. Canberra: Australian Government Department of Health and Ageing, 2000. Available at: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/nmp-objectives-policy.htm (accessed Nov 2005).<eMJA full text>
- Quality Use of Medicines (QUM) strategy. Canberra: Australian Government Department of Health and Ageing, 2000. Available at: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/nmp-pdf-natstrateng-cnt.htm (accessed Nov 2005).