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The use of an emergency medication kit (EMK) in

palliative care community practice.– The EMK Study

Dr Tracey Bullen*, Kate Maher, Dr John Rosenberg, Brad Smith

tracey.bullen@calvary-act.com.au Clare Holland House, 5 Menindee Dr, BARTON, A.C.T

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The EMK Project. Project aims

To determine if the provision of emergency medication packs in the patient’s home reduces preventable inpatient admission and unscheduled emergency home visits.

To evaluate the impact of EMKs upon caregiver self efficacy.

To conduct a nation wide survey of the prevalence of EMK usage .

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The EMK Project. Method

Caregiver/patient dyads were provided with an emergency medication kit and a medication diary to be used for educational purposes.

The EMK contained medications that addressed common emergent symptoms.

Caregivers completed a customised questionnaire about medication management at admission, 3mths and 6mths to assess perceptions of self efficacy.

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The EMK Project. Prevalence survey aims

To assess the prevalence of the use of emergency medication kits in community palliative care practice nationally.

The survey contained up to 15 items depending upon the responses provided exploring medication management and needs across services.

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The EMK Project. Preliminary Analysis

Patient data

Report the frequency of outcomes based on the audit form when the kits are accessed.

Questionnaire analysis

A correlation analysis will be conducted with all the self efficacy questionnaire items 1-12 to identify which items appear to be measuring the same constructs.

Descriptive factor analysis will be conducted with items 1-12 which look at feelings about medication management and perceived capability in managing medication.

A paired samples t test to look at individual differences across variables of self efficacy scores, over time if appropriate will be performed.

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The EMK Project. Patient preliminary results

100% recruitment rate of eligible dyads 28/58 patients recruited to date have died.

18/21 patients whose preferred place of death (PPOD) was at home died at home to date. 23/28 patients died in their known PPOD.

No patients have died in hospital The EMK has been accessed on 23 occasions.

Median time of kit access after admission was 10 days. Data suggests in over 90% of cases accessing the kit averted an acute admission to hospital or hospice.

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The EMK Project. Caregiver results

Professional opinion of the clinical staff reported the presence of the EMK had a positive impact upon caregiver confidence in 83% of cases (20/24).

Average age of caregivers 60.7yrs (SD=14.2, range = 28 – 89).

The majority of caregivers were female (66%) of their spouses (59%).

Average baseline scores for each item suggest an average score of 6.95 (SD=2.07 range = 0 – 10).

Preliminary correlations indicate that all items appear to significantly correlate with each other.

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The EMK Project. Prevalence survey results

28% (50/179) of invitees completed the survey. We received completed surveys from NSW, QLD, VIC (majority), SA and NT.

57% of respondents reported that their service did not use EM kits (25/48). Of these respondents 64% (16) stated the process did not meet patient needs or required improvement.

88% (22/25) stated that an EMK could improve patient outcomes. 67% (16/24) of respondents reporting needing to “chase parenterals” after a patient was admitted to the service more than once per month

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The EMK Project.What is working well/not so

well? What worked well/is working well

CNC screening for eligible patients (55% of all patients met eligibility criteria)

100% recruitment participation rate of eligible patient/carer dyads

What didn’t work well/isn’t working well Strict supervision of the recruitment process is required to ensure consent forms are returned in a timely fashion.

Completion of audit forms has not been consistent when kits are accessed since the launch of a new electronic system

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The EMK Project.Future directions

Recruiting sites where this approach to medication management is not currently occurring.

Further validation of the caregiver questionnaire i.e. concurrent validity with other self efficacy scales e.g. the revised scale for care-giving self efficacy .

Ideally conducting this trial across multiple sites where the community patient profile differs would strengthen the evidence base for this practice change.

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The EMK Project.

Any questions or feedback on this project would be appreciated