Background All patients prescribed long acting opioids should also be prescribed short acting opioid analgesia for breakthrough pain. This audit was piloted in a single site. Prescribing practice was poor so an implementation plan agreed trust wide. One year later audit data showed a significant improvement. Another year later improvement was maintained but not increased. One barrier was rotation of staff between trusts once educated. The authors were awarded funding from HQIP to develop a multi site audit as part of a quality improvement programme.

Standards National guidelines state that the short acting opioid dose should be one sixth of the total daily dose and no dose ranges prescribed. Opioids for breakthrough analgesia should be available as required, with a time limit between doses specified. This was agreed as hourly or two hourly. Targets: 90% of prescription doses to follow national guidelines 100% of prescription frequencies to follow guidelines 100% of prescriptions for a single dose, not a range.

Methodology Service improvement methodology is being used for the whole audit process. Quantitative data on prescribing practice has been collected on 717 prescriptions from across 8 acute trusts. All healthcare professionals in each trust were sent a survey to help determine the underlying causes of poor prescribing practice. An audit lead in each trust recruited an improvement team to attend a 1 day service improvement workshop focused on data analysis, determining root causes, applying a priorities framework to these and establishing detailed action plans to address one priority issue in each trust. Action learning sets will be offered to site leads for 1 year followed by reaudit.

Results Data will be presented demonstrating poor prescribing practice, varying significantly between trusts. Survey data will also be presented.

Conclusion Common errors in opioid prescribing practice will be shared with underlying causes and implementation plans.