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32 Opioid calculations via biscuits
  1. Elizabeth O’Brien,
  2. Lindy Brooks and
  3. Alicia Waite
  1. Manchester Macmillan Support and Palliative Care Service – North Locality


Background Specialist Palliative Care practitioners tend to have a familiarity with the mental gymnastics to calculate equipotent doses of analgesia and ensuring safe calculations is critical to medicines safety. All healthcare colleagues who manage medications should be aware of the relative strengths of strong opioids but achieving this with a wide range of learning styles can be a challenge. A hands on education module with a more visual component was developed to address aspects of the VARK learning styles for both district nurses and specialist colleagues.

Methods To develop practical and memorable education in opioid relative strengths a ‘biscuit equivalence unit of 5 mg oral morphine’ was used. Commonly used opioids were identified and given to attendees in pairs to calculate how many ‘biscuit equivalent units’ the medication total daily dose represented. Actual wrapped biscuits were utilised (and eaten during the session) to show the relative strengths of common opioids ie morphine orally and via CSCI, fentanyl and buprenorphine patches and oxycodone.

Results The educational session has to-date been run 2 out of a planned 3 sessions with requests to provide at additional locations. All attendees have provided positive feedback and reflected that it was a novel way of understanding relative strengths of opioids. It provided the opportunity to rediscuss opioid strengths and the visual pile of biscuits, in particular for fentanyl patches, provided a very memorable point of reference.

Conclusion Understanding opioid doses and relative strengths of medications is a central aspect of safe medication management. Ways of making this more memorable for practitioners will improve their familiarity and safety in using these medications and supporting patients and families in their safe use. We often say that a cup of tea and a biscuit go a long way in conversation, their use in education may be just as effective.

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