Education initiative improves the evidence-based use of metoclopramide following morphine administration in the emergency department


  • Bernard SK Yeoh, MB BS, Registrar; David McD Taylor, MD, MPH, DRCOG, FACEM, Director of Emergency and General Medicine Research; Simone E Taylor, PharmD, GCCRM, Senior Pharmacist.

Professor David McD Taylor, Emergency Department, Austin Health, Studley Road, Heidelberg, Vic. 3084, Australia. Email:


Objective:  We aimed to evaluate a multifaceted education initiative designed to reduce the prophylactic use of metoclopramide.

Methods:  This was a pre- and post-intervention trial undertaken in a single ED. All ED doctors and nurses were targeted. The intervention comprised a specifically designed, 19-slide ‘e-learning module’, accessible via the ED intranet, supplemented by in-service training and a range of reminder techniques (posters, emails and drug room flyers). The primary end-point was the proportion of patients administered metoclopramide prophylactically with their initial morphine dose. Data were collected on random samples of patients who received morphine, using explicit medical chart review.

Results:  Both pre- and post-intervention periods were of 3 month duration. The charts of 146 cases were reviewed in each period. In the post-intervention period:

• The proportion of patients administered metoclopramide prophylactically decreased from 22.6% to 4.1% (difference 18.5% [95% CI 10.3–26.7], P < 0.001)

• The proportion of patients administered metoclopramide appropriately (for known morphine sensitivity, established nausea and rescue anti-emesis) rose marginally from 28.8% to 32.9% (difference 4.1% [95% CI −7.2–15.4], P = 0.53)

• There was a 12.7% decrease in the number of ampoules of metoclopramide issued to the ED without a concurrent rise in the issue of other anti-emetic drugs

Conclusion:  The education initiative resulted in a significant improvement in the evidence-based use of metoclopramide.