Background The Scottish Palliative Care Guidelines (SPCG) provide guidance for initiating lidocaine 5% patches and assessing their efficacy. As most patients will respond within 1–2 weeks, patches should be reviewed around this time, by way of a patch-free trial, and discontinued if not beneficial.
In Roxburghe House hospice, Dundee, lidocaine patches are not routinely reviewed. My aim was to educate prescribers regarding national guidance, and to encourage them to review lidocaine patches 1–2 weeks after initiation.
Methods A record was kept of all inpatients who commenced lidocaine patches in Roxburghe between 1st December 2015 and 29th February 2016. Indication for starting patch, pain assessments and outcome of patch-free trial were all recorded.
Following cycle 1 I provided education sessions about the SPCG guidance for prescribers in Roxburghe. I introduced an assessment sheet based on the SPCG recommendations. I then repeated the data collection with patients who commenced lidocaine patches in Roxburghe House between 1st July and 30th September 2016.
Results Cycle 1 confirmed that the SPCG guidance was not being followed in Roxburghe House. Only one patient had a patch-free trial and the majority of patients had no pain assessment at 48 hours or 1–2 weeks.
In cycle 2 100% of patients had pain scores documented, although only 50% had the new assessment form completed. Of the patients who survived past 1–2 weeks, 100% had clear instructions to their GP requesting review of the patch in the community.
Conclusions The introduction of a lidocaine patch assessment form has had some success so far in Roxburghe House, however further education is required to reinforce the importance of following the SPCG guidance. Other interventions which may be interesting would be providing education updates on the SPCG guidance for GPs and formulating an information leaflet for patients which provides instructions for how and when to initiate a patch-free trial.
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