Quality Use of Medicines (QUM)/Drug Usage Evaluation (DUE) Hospitals Program

Page content: Overview | Victorian Drug Usage Evaluation Group | Previous VDUEG initiatives | Victorian DUE group membership | Further information | Drug usage evaluation and ethics | Drug usage evaluation references | DMACS project | APOP project | CAPTION | Emergency department use of antibiotics for lower respiratory tract infections | Statewide evaluation of ceftriaxone & cefotaxime usage in Victorian hospitals | Statewide evaluation of vancomycin & teicoplanin usage in Victorian hospitals

Overview

The Quality Use of Medicines/Drug Usage Evaluation (QUM/DUE) program is funded and supported by the National Prescribing Service Limited (NPS) and co-managed in Victoria by the Department of Human Services and the Victorian Drug Usage Evaluation Group (VDUEG).

The program objectives are to implement guidelines for improved prescribing and medicine use in hospitals and the community.
Program initiatives include:

• management of acute coronary syndromes at discharge (DMACS)
• management of acute postoperative pain (APOP)    

Victorian Drug Usage Evaluation Group

The Victorian Drug Usage Evaluation (DUE) Group was formed in 1996 to consolidate the statewide network of healthcare professionals involved in drug usage evaluation. The aim of the group is to coordinate and develop DUE activities in Victorian hospitals.

Previous VDUEG initiatives

• Community-Acquired Pneumonia: Towards Improving Outcomes Nationally (CAPTION)
• emergency department use of antibiotics for lower respiratory tract infections
• statewide evaluation of ceftriaxone and cefotaxime usage in Victorian hospitals
• statewide evaluation of vancomycin and teicoplanin usage in Victorian hospitals

Victorian DUE group membership

  VDUEG members list (27kb, pdf)

Further information

For further information on the QUM/DUE hospitals program in Victoria, contact the Senior Project Officer, Quality Use of Medicines Program on (61 3) 9096 9038.

For further information on the national QUM/DUE hospitals program, contact the NPS on (61 2) 8217 8700.

For enquiries regarding membership of the Victorian DUE Group contact the chair, Marion Robertson, telephone (61 3) 9342 7612.

Drug Usage Evaluation and Ethics

A useful paper titled "When does quality assurance in health care require independent ethical review?" produced by the National Health and Medical Research Council (NHMRC) is available from the NHMRC website.

Drug Usage Evaluation References

• SHPA Standards of Practice for Drug Usage Evaluation in Australian Hospitals May 2004, J Pharm Pract Res 2004; 34(3):220-3.
  

Discharge Management of Acute Coronary Syndromes (DMACS) Project

Overview

The DMACS project aims to improve the quality of acute coronary syndromes (ACS) management at discharge in Australian hospitals. The project commenced in June 2008. DMACS key messages:

Methodology

• There are 16 Victorian hospitals, (12 public hospitals and 4 private hospitals) taking part.
• A baseline audit of current ACS management at discharge was conducted in each hospital; this involved an inpatient medical record review, a fax/postal survey of GPs and a 90 day follow-up telephone call with patients.  
• An educational intervention is currently being undertaken in DMACS hospitals. The project’s educational materials were developed from the National Heart Foundation/Cardiac Society of Australia and New Zealands’ 2006 ACS management guidelines.

Educational materials include:

• academic detailing cards
• reminder bookmarks
• generic PowerPoint presentations
• a wallet-sized chest pain plan
• ACS discharge summary template and checklist.

Results and further information

A follow-up audit will be undertaken following the DMACS education. DMACS is scheduled for completion in late 2009.

For further information regarding DMACS, contact the Senior Project Officer, Quality Use of Medicines Program, on (61 3) 9096 9038.

• NPS DMACS for participating hospitals

Acute Postoperative Pain (APOP) Project

Overview

The APOP project aimed to improve the quality of acute postoperative pain management in Australian hospitals. The project started in 2006 and was completed in 2008.
APOP key messages:

Methodology

• APOP was undertaken in 63 Australian hospitals including 20 Victorian hospitals (18 public and 2 private).
• An audit assessing current practices in acute postoperative pain was undertaken, with 50 surgical patient records audited in each hospital. A brief inpatient interview was also conducted to explore the patient’s experience of pain, effectiveness of administered analgesia and also postoperative nausea and vomiting.   
• An education program was subsequently carried out, with the project’s educational materials developed using the Australian and New Zealand College of Anaesthetists ‘Acute pain management: scientific evidence’, second edition 2005, and the Therapeutic Guidelines: Analgesic, version 4 2002.
• Materials developed include academic detailing cards, reminder bookmarks, generic PowerPoint presentations and wall posters. APOP also promoted the use of the acute pain assessment toolkit developed by the Victorian Quality Council.

Results and further information

A follow-up audit demonstrated some moderate improvements in the quality of acute postoperative pain management:

• Documented preoperative patient education on pain management increased from 31% to 44% (p<0.0001)
• Proportion of postoperative patients with at least one pain score recorded increased from 57% to 77% (p<0.0001)
• Proportion of postoperative patients prescribed opioids with at least one sedation score recorded increased from 50% to 61% (p<0.0001)
• Proportion of patients with a documented pain management plan at discharge from hospital increased from 26% to 40% (p<0.0001)

The outcomes of the APOP project were presented at the National Medicines Symposium in Canberra in May 2008.

APOP national data at NMS - 2008 (231kb, pdf)

Note that a public website containing the APOP educational materials and a standalone software audit tool is now available via the NPS website.

For further information regarding APOP contact the Senior Project Officer, Quality Use of Medicines Program, on (61 3) 9096 9038.

Community-Acquired Pneumonia: Towards Improving Outcomes Nationally (CAPTION)

This Australia-wide quality improvement initiative was supported by the NPS and was conducted by the VDUEG in Victoria.

• The CAPTION project aimed to implement the Antibiotic Guidelines, version 12, 2003 (Guidelines), for the treatment of community-acquired pneumonia (CAP) in 37 hospital emergency departments over a two-year period, including antibiotic prescribing and the use of a severity assessment tool, the Pneumonia Severity Index (PSI).
• The CAPTION educational intervention program included academic detailing (1:1 educational sessions), group feedback presentations, posters, stickers and ID reminder cards.
• In Victoria, a four-fold increase in the documented use of the PSI coupled with a moderate improvement in concordance of antibiotic prescribing for CAP with the Guidelines was achieved.

 The national baseline data have been published in The Medical Journal of Australia 21 November 2005 183 (10): 520-524. A full state report is available to download below.

Community-Acquired Pneumonia: Towards Improving Outcomes Nationally. The CAPTION Project – A Multi-centre Drug Usage Evaluation Study. Report to the National Prescribing Service April 2006 (845kb, pdf)

For further information on CAPTION and to order project materials, contact the National Prescribing Service on (61 2) 8217 8700.

Emergency department use of antibiotics for lower respiratory tract infections

The Victorian DUE Group in collaboration with the New South Wales Therapeutic Assessment Group (NSW TAG) and the Queensland DUE Group was funded by the NPS to carry out a multi-centre study of the antibiotic treatment of lower respiratory tract infection in emergency departments (EDs). The Victorian DUE Group was responsible for the coordination of the study.

The aims of the study were:

• To determine patterns of antibiotic use for the treatment of lower respiratory tract infections in EDs in Victoria, New South Wales and Queensland.
• To describe previous antibiotic use, severity and characteristics of presentation, and comorbidities for patients treated for respiratory tract infections and correlate with antibiotic use.
• To compare antibiotic use with recommendations in national prescribing guidelines.
• To determine the destination for patients on leaving the ED e.g. ward, home etc.
• To describe antibiotic policies and access to guidelines in EDs.

Twelve hospitals (8 in VIC, 3 in NSW and 1 in QLD) participated in the study. Data collection was undertaken from April 2001 until July 2001 with a total of 603 patients enrolled.

A pdf version of the study report is available to download below:

Antibiotic Treatment of Lower Respiratory Tract Infection in Emergency Departments - Report to the National Prescribing Service and the Victorian Drug Usage Advisory Committee May 2003 (1mb, pdf)

For further information, contact the study co-ordinator:

Marion Robertson
Telephone: (61 3) 9342 7612

Statewide evaluation of ceftriaxone & cefotaxime usage in Victorian hospitals

This study evaluated the use of ceftriaxone and cefotaxime and was completed in August 2000.

• Fifty-one hospitals throughout Victoria participated in the study.
• Usage was widespread across all hospitals (public, private, metropolitan and regional) with an average rate of use per hospital of approximately 40 courses per 1000 inpatient separations per week.
• Empirical treatment of infection accounted for 82 percent of all courses, and surgical prophylaxis for 15 percent. More than half the courses were given for respiratory tract infection.
• Less than 30 percent of the courses were assessed as concordant with the Therapeutic Guidelines: Antibiotic 10th edition.
• In many cases lack of concordance resulted because there was no evidence of pneumonia on the chest x-ray or the pneumonia could not be classified as severe according to the Antibiotic Guidelines.

This study highlights areas requiring intervention, i.e. the treatment of respiratory infection and use of cefotaxime and ceftriaxone in surgical prophylaxis.

The finding that two major metropolitan teaching hospitals with tight prescribing restrictions had lower than average use, whereas, a comparable hospital with unrestricted prescribing had a higher than average use, may indicate benefit in restrictive policies.

This study was published in The Medical Journal of Australia 3 June 2002 176 (11): 524-529.

Statewide evaluation of vancomycin & teicoplanin usage in Victorian hospitals

This multisite study evaluating the use of vancomycin and teicoplanin was undertaken in 1997. A report titled 'Vancomycin and Teicoplanin use in Victorian Hospitals' has been published in The Medical Journal of Australia 2 August 1999; 171(3): 127-131. 

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