Background After receiving reports of 5 deaths and over 4200 dose-related patient safety incidents concerning opioid medicines up to June 2008, the UK National Patient Safety Agency issued a rapid response report.1 The NPSA issued guidance that should be applied when prescribing, dispensing or administering opioids.
Aims and objectives The aim of this project was to assess the current prescribing of schedule 2 and 3 opioids in teaching hospital and identify preventable errors over a 2-week period.
Method Over a 2-week period, pharmacists on medical wards identified patients receiving schedule 2 or 3 opioids for chronic pain, whether the patient was admitted on treatment or it was newly prescribed. This generated a list of inpatient charts that were audited prospectively against local and national guidelines.
Results Seventy patients who had been prescribed opioids for chronic pain were identified. The majority of prescriptions (56%) were written by FY1 doctors. Most of the patients (83%) were already prescribed regular opioids on admission; 81% were prescribed the correct opioid dose as per admission drug history, while the 19% were purposefully changed to new treatment. Dose changes were performed correctly in 80% of the cases, with increases being within 30–50% of the previous dose. Two thirds of ‘as required’ doses were prescribed inadequately, either not being prescribed at all, or the dose had not been calculated as 1/6 of the background dose. Almost three-quarters (73%) of patients were not co-prescribed a laxative.
Discussion/conclusion During this audit two main areas of error with opioid prescribing were highlighted: prescription of ‘as required’ medication and appropriate co-prescription of a laxative. The results suggest that prescribers are not familiar with certain aspects of opioid treatment. Since the majority of prescribing was performed by junior doctors, this study has highlighted the need for additional education and training.
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