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MP26: An emergency department team-based quality improvement initiative reduces narcotic and benzodiazepine ‘to-go’ medication administration

  • D. Harris (a1), D. Karogiannis (a1), N. Balfour (a1), M. Gerry (a1), J. Mushta (a1) and J. Cabral (a1)...
Abstract

Introduction: The administration of “to-go” medications in the Kelowna General Hospital Emergency Department was identified as an issue. Frequently, multiple administrations of “to-go” medication pre-packs were administered to individual patients on a frequent basis. In addition, the variability in “to-go” medication was substantial between providers. Recognizing the patient issues (addiction, dependency and diversion) and system issues (costs, risk) a team-based quality improvement initiative was instituted, utilizing a variety of quality improvement techniques. The aim was to reduce the number of “to-go” medications by half, within a year. Methods: The project began January 2015, and is ongoing. Multiple stakeholders were engaged within the emergency department; these included leaders of the physician, nursing and pharmacy teams, including an executive sponsor. Using change theory, and traditional Plan-Do-Study-Act (PDSA) cycles, an iterative methodology was proposed. The outcome measure proposed was number of “to-go” medications administered; secondary measures included number of opioid “to-go” and benzodiazepine “to-go“prescriptions. Balancing measures were the number of narcotic prescriptions written. Physician prescribing practice and nursing practice were reviewed at meetings and huddles. Individualized reports were provided to physicians for self-review. Data was collated at baseline then reviewed quarterly at meetings and huddles. Run charts were utilized along with raw data and individualized reports. Results: At baseline (January 2015), the number of “to-go” medications was 708. Over the next year, this value reduced to 459, showing a 35% reduction in “to-go”. Two years later (June 2017), this had reduced to 142, resulting in an overall reduction of 80% “to-go” medications. Secondary measures are currently under analysis. Further, no increase in prescribing of narcotics was seen during this time period. Conclusion: The administration of “to-go” medications from the emergency department has significant individual and societal impact. Frequently, these medications are diverted; meaning, sold for profit on the black market. Further, opioid prescribing is under increased scrutiny as the linkage between opioid prescriptions and addiction / dependency becomes more evident. This quality improvement initiative was successful for a number of reasons. First, we had strong engagement from the full emergency department clinical teams. The issue was first identified collaboratively, and teamwork and participation was strong from the outset. Second, we used individual and aggregate data to provide feedback on a regular basis. Third, we had strong support from our executive sponsor(s) who were able to support the efforts and champion and present the results locally, and now, throughout the Health Region.

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Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
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