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11 One opioid conversion workbook, three settings: community, hospices, hospitals
  1. Robert Brodrick,
  2. Sylvia Reid and
  3. Sarah Mollart
  1. Norfolk and Norwich University Hospital, Sue Ryder Thorpe Hall Hospice, St Nicholas Hospice Care, West Suffolk Hospital


Background Despite a near absence of rigorous training programmes, safely converting between strong opioids is a key skill for palliative care clinicians, regardless of setting.

To address this deficit, we developed the Opioid Conversion Workbook (OCW), an educational intervention to teach complex conversion calculations between morphine (oral and subcutaneous), oxycodone (oral and subcutaneous), transdermal buprenorphine, transdermal fentanyl and subcutaneous alfentanil.

Aims To assess whether the OCW produced improvements in opioid conversion ability in different professions, clinical settings and experience levels, and whether these improvements were sustained.

Methods Participants were selected across the East of England from the palliative care teams of a university teaching hospital, a district general hospital, two community clinical nurse specialist (CNS) teams, and two specialist palliative care inpatient units (IPU).

Each participant answered 17 clinically relevant calculation questions as a baseline assessment under exam conditions. They then completed the OCW over 6 weeks, before taking a different but structurally symmetrical 17 question final assessment. One year after completing the OCW, a proportion of participants took an ability retention assessment under exam conditions.

Results 141 clinical staff took part: 64 hospice IPU nurses, 35 hospice doctors, 17 hospital CNS, 2 hospital doctors, 18 community CNS, and 5 clinical managers. The length of time working in palliative care ranged from 1 week to 25 years.

The median baseline assessment score was 34% (5.79/17; range 0 to 17). Following completion of the OCW, the median final assessment score was 99.8% (16.96/17; range 15 to 17).

12 months later, 23 staff took the ability retention assessment. The mean score was 91.8% (15.6/17; range 8 to 17).

Conclusions The OCW generated significant improvements in opioid conversion ability for a wide range of palliative care staff, in a variety of clinical settings. Most of this improvement was sustained, suggesting long-term skill retention.

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