Background Substance misuse (including alcohol) is a growing issue in the UK and can have far reaching effects on wellbeing, symptoms, compliance, social support and ability to access services. Medications with a potential for misuse are used commonly in palliative care. Patients with substance misuse should receive the same standard of care and treatment of symptoms as other patients. Providing this care across settings and reducing risks requires multi-agency working and good communication between healthcare professionals. Regional guidance relating to this exists in Mersey from 2009.

Aims To review current documentation of key information in patients known to palliative care with substance misuse in the Mersey region as part of updating the regional guidance.

Methods A retrospective multi-centre case-note audit was conducted including documentation of key information in patients with life limiting illness and known substance misuse receiving specialist palliative care in hospital, hospice and community settings.

Results 73 cases across the three settings were included (22% community, 40% Hospice, 37% Hospital). 73% had documentation of whether drug and alcohol services were involved, 53% had documentation of whether a key worker was involved. For the 24 patients on opioid-substitution therapy (OST) 22% had information about their community pharmacist documented, 74% had documentation of their named prescriber for OST and 63% had documentation of their named prescriber for opioids. Documentation of communication with community teams following changes to opioid medications varied: GPs 61%, drug and alcohol teams 12%, and community pharmacists 5%. The method of communication also varied.

Conclusions This audit highlighted inconsistent documentation of important information relating to substance misuse in patients with life limiting illness that could impair communication between healthcare professionals and services, potentially affecting the care and safety of these patients. These results have helped to inform the update of the regional guidelines in Mersey.