Background This audit was completed to review adherence to the current 2012 Pan Birmingham guidelines for the use of methadone in adults with pain in palliative care.

Methods Anonymised data collection tools were sent electronically to six hospices in the West Midlands. Data was collected retrospectively from controlled drugs record books over a 2 year period from 01/07/2013–30/06/2015. The audit was limited to patients who were inpatient at the hospice and excluded those who were admitted already taking methadone on admission or taking it for an alternative reason eg, as part of a drug replacement programme.

Standards for the audit were derived from the current 2012 Pan Birmingham Guidance.

Results Results were received from five hospices. In total 28 patients were audited retrospectively over a 2 year period from July 2013 to June 2015. Ten patients were excluded. A protocol or guideline was in use in only 2 hospices (40%). Of the 18 patients included in the audit methadone was commenced in 14 patients (78%) due to poorly controlled pain despite other opiates. In one patient it was commenced due to tolerance to the analgesic effects of other opiates. In three patients methadone was commenced due to unacceptable side effects of other opiate medications. An ECG was performed prior to commencing methadone in only three patients. A variety of starting doses of methadone were used, most commonly 30 mg. Furthermore, breakthrough dosages of methadone prescribed were wide ranging from 2–30 mg.

Conclusions This audit shows that the current local guidelines are not always being adhered to. A wide variation in prescribing exists for both regular and PRN dosages of methadone. Additional areas for improvement have been identified including nursing training and QTc monitoring with pretreatment ECG.