Introduction There are guidelines on the prescription of opioids relating to choice in renal impairment and the ratio of modified release to immediate release. When prescribing opioids, it is essential patients understand what they are, how to take them, and they are counselled on side effects and limitations. Staff must also understand prescribing and counselling regarding opioids.
Method 2 part study:
1. Service Evaluation - Questionnaires filled in by both staff and patients, regarding their prescribing, knowledge and perception of opioids.
2. Audit - Comparing whether patients are prescribed the correct opioid in relation to their renal function, and whether the ratio of modified release opioid to immediate release is correct.
Results At the time of writing, we had 36 patient and 10 staff responses to the questionnaires, as well as 45 recordings of patients‘ MR:PRN ratio. We had reviewed approximately 700 prescriptions of opioids to compare with renal function.
Service Evaluation: 80% of staff said they never provided opioid information leaflets to patients, and many staff mentioned fear associated with opioid dependence and terminal illness when prescribing. 22.2% of patients could not name the opioid they were receiving, and only 16.7% said they had received the opioid information leaflet.
Audit: 30% of patients with an eGFR <30 had been prescribed morphine (in contrast to guidelines). 67% patients had an incorrect MR:PRN ratio.
Conclusion and further work Staff showed good competency levels of opioid understanding and prescriptions but many patients had not been given adequate information regarding opioids. The audit shows reasonable prescribing of opioids in renal impairment however need for education about MR:PRN ratios. We aim to further educate staff about opioids and their prescription and also trial a full roll out of our patient leaflet ‘strong opioids for cancer pain’ re-auditing its use over the next year.
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