The Joint Commission Journal on Quality and Patient Safety
An Observational Analysis of Medication Use During 5,727 Medical Emergency Team Activations at a Tertiary Referral Hospital
Section snippets
Ethical Considerations
This study received human research ethical approval from the Alfred Hospital Ethics Committee (approval number 240/15) and Monash University Human Research Ethics Committee (CF153762 2015001634). A waiver of participant consent was granted.
Setting
The Alfred is a 500-bed university-affiliated tertiary referral hospital in Melbourne providing a comprehensive range of adult specialist medical, surgical, and mental health services. A mature two-tier RRS was activated by single-parameter derangement as
All MET Activations and Patients
During the study period, there were 64,625 same day and multiday admissions and 5,735 MET activations, which equated to 89 MET activations per 1,000 admissions. After application of exclusion criteria, there were 5,727 MET activations involving 2,955 patients available for analysis (Figure 1). Repeat MET activations for the same patient during the study period were common (42.8%; median = 1; range = 1–29). There were 3,277 first activations, 1,226 second, 532 third, and 692 fourth or greater
Principle Findings
In this single-center study we found that medications were used at one third of 5,727 consecutive MET activations. Cardiac therapies, electrolytes, and analgesics were administered most frequently. Most medications used during MET activations were accessed from ward stocks. MET activation criteria, including high blood pressure, heart rate, respiratory rate, and uncontrolled pain, rather than demographics or repeated activations, would appear to be indicative of predicting the need for and type
Conclusion
Medication use and access during MET activations were common and heterogeneous. This understanding resulted in local initiatives to improve MET practice, which have potential to be more generally applicable. However, associations between medication use and MET activation criteria and outcome warrant exploration. Future research should be prospective, be multicenter, use recognized classification systems, and focus on improving medication management from MET activation, through treatment
Funding
Bianca Levkovich was supported by an Australian Government Research Training Program Scholarship. D. J. (Jamie) Cooper was supported by an Australian National Health and Medical Research Council Practitioner Fellowship.
Acknowledgments
The authors acknowledge the contribution of Dr. Irma Bilgrami to the conception of the study and Dr. Eldho Paul for inferential statistical analyses.
Conflicts of Interest
All authors report no conflicts of interest.
Bianca J. Levkovich, MSc, is Honorary Research Pharmacist, Alfred Health, and PhD Candidate, Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne.
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Evaluation of medical emergency team medication management practices in acute hospitals: A multicentre study
2022, Australian Critical CareCitation Excerpt :Lack of timely access to antibiotics by the MET is a problem identified by others.15 Studies from three Australian tertiary teaching hospitals described electrolytes, antiarrhythmics, furosemide (frusemide), vasopressors, and opioid analgesics as the most commonly used medications at MET activations.5,14,23 In the present multicentre study, dedicated MET medication supplies often did not include all of these agents.
Dynamic early warning scores for predicting clinical deterioration in patients with respiratory disease
2022, Respiratory Research
Bianca J. Levkovich, MSc, is Honorary Research Pharmacist, Alfred Health, and PhD Candidate, Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne.
Gordon Bingham, PhD, is Chief Nursing Information Officer and ICU Liaison Nurse, Alfred Health.
Ria E. Hopkins, MPH, is Pharmacy Research Assistant, Alfred Health.
Daryl Jones, MD, PhD, is Associate Professor, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, and Consultant, ICU, Austin Hospital, Melbourne.
D. J. (Jamie) Cooper, MD, is Head of ICU Research and Deputy Director, Department of Intensive Care, The Alfred, Melbourne, and Director, ANZIC-RC.
Carl M. Kirkpatrick, PhD, is Director, CMUS.
Michael J. Dooley, PhD, is Director of Pharmacy, Alfred Health, and Professor of Clinical Pharmacy, CMUS. Please address correspondence to Biana J. Levkovich, [email protected].