Background Lancashire Medicines Management Group has clear regional guidance for prescribing strong opioids, adhering to generally accepted practice that the breakthrough dose of a strong opioid should be 1/6th to 1/10th of the regular prescription. We wished to assess if opioid prescribing in The Royal Blackburn Hospital (an Acute NHS Trust) was in line with these recommendations.

Methods The medication charts of all inpatients on five different acute medical wards at The Royal Blackburn hospital were reviewed. All strong opiate breakthrough prescriptions were identified and assessed for compliance with guidance. Following this, teaching sessions were provided for junior medical staff after which the data collection was repeated on the same wards.

Results In the first set of data, overall compliance with the guidelines was 63%.

• 100% of the prescribing decision made by specialist teams i.e. the specialist palliative care nurses were correct.

• 50% of the prescribing decisions made by doctors were compliant.

In the second set of data overall compliance with the guidelines was 50%.

• There was no input from specialist teams for any of the prescribing decisions.

• 50% of the decisions made by doctors were again complaint.

Conclusions These results demonstrate a failure of teaching on opioid prescription to materially alter the prescribing habits of junior medical staff. They also show the utility of specialist input, the absence of which led to a higher overall rate of sub-optimal prescribing decisions. Whilst we should continue to try to improve adherence to the guidelines by doctors, it remains imperative that clinical teams continue to consult with specialist teams i.e. palliative care.