Background The Gosport Inquiry (GI) found that unsafe opioid use led to around 450 excess deaths over 14 years. We compared their findings to local, current use in a hospice and hospital setting.
Methods Notes were reviewed retrospectively for inpatient deaths in January 2019 at Ealing Hospital and Meadow House Hospice. We collected the same data as was analysed in the GI, using notes and drug charts. We focused on indications, doses and routes of administration of opioids.
Results At the hospice, 92% (24/26) of patients received regular opioids. 100% (26/26) had appropriate indications documented. The mean initial dose was 30 mg oral morphine equivalent per day; the mean final dose was 35 mg. 62% of patients (16/26) were switched to continuous subcutaneous opioid administration prior to death. At the hospital, 42% (26/62) of patients received opioids. 23% (14/62) received regular opioids, and of these 93% (13/14) had appropriate indications documented. The mean initial dose was 20 mg oral morphine equivalent per day; the mean final dose was 24 mg. Of total deaths, 5% (3/62) received opioids via continuous subcutaneous infusion, 18% (11/62) were reviewed by palliative care. The narrative in the notes suggested a lack of confidence in prescribing opioids and diagnosing dying.
Conclusions It is reassuring that opioid use at both sites appears safe. In contrast to the GI, opioid doses used were low and indications well documented. The proportion of patients receiving opioids was lower at the hospital than the hospice, with an apparent preference for low dose, immediate release rather than background opioids. The size of the difference could represent truly different patient populations, or could be under-utilisation of opioids as a result of lack of confidence or education. This signposts possibilities for future investigation as to why this might be, and potential improvements to clinical practice.
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