Background With recent attention looking at opioid prescribing, the potential dangers with use in non-malignant pain conditions, increasing scrutiny on their indication, use and monitoring is now required. As supportive and palliative care verve into the earlier trajectories with conditions other than cancer, the traditional approach to escalating doses of strong opioids to manage mainly pain and breathlessness is being challenged emerging research.
Aim To explore the use of strong opioids within a hospice setting and to scrutinise the supporting documentation.
Methods Retrospective case-note review of patients within an inpatient and community hospice setting over a 3 month period.
Results 64 inpatient and 67 community case-notes were reviewed; 77% and 46% of patients having strong opioids when first reviewed by the hospice teams respectively. The most common opioids were morphine sulphate (26% vs.16%), diamorphine (20% vs. 4%) and oxycodone (20% vs. 4%) with most inpatients (91%) having had clear documentation to support the indication, use, dose changes and opioid rotation rationale. The proportion of patients that subsequently died (51/64) within the inpatient unit, nearly all (50/51=98%) had some form of subcutaneous opioid prescribed regularly at their time of death. The comparison within the community was possible given the multiple health providers involved in prescribing of end of life medications.
Conclusions The findings from this piece of work provide reassurance that strong opioids when used within an inpatient hospice setting are used proportionally, with clear indication and rationale for their use. The community based practice supported by hospices identities key concerns in terms of clarity and consistency in the prescribing of strong opioids in the last days of life. Given the multiple provider partners within the ever merging health landscape, clear and shared protocols identifying the responsible organisation to lead on opioid prescribing and their clear rationale will be key.
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