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Would you like to track your quality improvement process and reduce costs at the same time? A medication use study can help you do exactly that, according to James Augustine, MD, FACEP, who serves on the board of directors of Premier Health Care Services, a Dayton, OH-based physician management group that provides staffing and consulting services. Premier tracked medication usage at 10 EDs. "This offers a snapshot of the clinical practice in the ED," Augustine says. "There are few other quantitative measures to gauge the efforts to educate staff on best practices in the ED."
A medication study can improve consistency of physician behaviors and reduce costs, adds Bruce Janiak, MD, FACEP, director of the department of emergency medicine at Toledo (OH) Hospital. "Monitoring effectiveness allows an ED to facilitate evidence-based change," Janiak says.
According to Augustine, medication usage studies also offer opportunities to reduce care variance, manage risk, decrease complaints, increase patient satisfaction, and improve clinical outcomes. "This is accomplished by an active and timely review of the data, identification of care patterns that lead to the usage of certain medicines, and then ongoing education of staff," he says.
Here are some benefits of tracking medication usage:
• Pain management is improved.
The study assessed whether staff was providing appropriate pain control while the patient is in the ED, says Augustine. "We have been adding pain scales to our documents, but there is a reality check’ when you measure the administration of pain control medicines," he says. The increased use of pain medicines in the ED, especially oral narcotic medicines, is a good measuring stick to assess these efforts, says Augustine. "This is great objective evidence that the staff is looking for opportunities to offer pain control," he says. Similarly, use of antibiotics, breathing treatments, gastrointestinal medicines, anti-inflammatories, and certain sedatives represent an effort by ED staff to resolve symptoms in the ED, he adds.
• Drug-impaired clinicians are identified.
Tracking drug usage will usually allow you to spot a clinician who abuses drugs, says Janiak. "Monitoring of inappropriate usage of drugs with abuse is a potential early warning of a professional in trouble," he says. "The latest method for tracking is a system such as Pyxis [Pyxis Corp., San Diego], a machine that dispenses drugs, including narcotics, in the ED," he says. "It requires a code to be entered and records usage. Therefore, if an individual is found to access an inordinate amount of narcotics, the abuse is discovered."
• There is improved use of antibiotics.
The study revealed that patients admitted to the hospital with infectious disease diagnoses were not getting antibiotics in the ED, notes Augustine. As a result, the ED physicians were educated about the benefits of giving a first dose of antibiotics in the ED. Some ED physicians did this before cultures were complete, while others thought that the best practice was to wait until the appropriate attending was contacted, Augustine explains. "Once the group realized the variance in practice, it was addressed," he says.
First, key members of the medical staff were invited to address the ED group, so that a uniform approach could be developed, says Augustine. "We received input from infectious disease specialists, who urged that antibiotics be given before cultures, and from internists, who appreciated the emergency physicians getting the first dose in before they were called," he says. Even the surgeons approved the first dose of antibiotics, because it improved surgical outcomes for the sickest patients, he adds.
Next, it was determined that patients admitted for pneumonia through the ED had significantly shorter hospital lengths of stay and better outcomes than those patients who were direct admits to the floor, says Augustine. "This was because direct admits to the floor waited hours longer for the first antibiotic dose," he explains. The use of all intravenous antibiotics in the ED increased, as the ED physicians became consistent in the aggressive management of potential or identified infectious diseases, says Augustine.
• Use of expensive medications is reduced.
The study also measured progress in reducing the use of expensive medicines that may have effective alternatives, says Augustine. "If you are concerned about the use of a very expensive medicine in the ED and feel that other medicines would offer equivalent or better clinical results, you may consider asking the lead clinical pharmacist and the medical director to address the emergency physician group," he suggests. The results of that effort to educate the ED physicians would be measurable immediately through a medication use study, he adds.
The Premier study found that a few expensive drugs account for much of the total drug costs in the ED, says Augustine. (Click here to see charts on Our Most Costly Medicines, Others Medicines of Note with Alternatives, and One ED Costs Study.) "If it is a priority for the ED to reduce the use of some of these expensive medicines, this study will give the data on an almost real-time basis," he explains. "Then education of the ED physicians and nurses can take place with objective numbers."
For more information about tracking medication usage, contact:
• James Augustine, MD, FACEP, Premier Health Care Services, 8111 Timberlodge Trail, Dayton, OH 45458. Telephone: (937) 435-1072. Ext. 102. Fax: (937) 435-8626. E-mail: email@example.com.
• Bruce Janiak, MD, FACEP, Department of Emergency Medicine, Toledo Hospital, 2142 N. Cove Blvd., Toledo, OH 43606. Telephone: (419) 291-4111. Fax: (419) 291-2142. E-mail: Bruce.Janiak.MD@ProMedica.org.