Introduction Opioids are commonly used drugs in palliative care, in both healthcare and community settings. The risk for harm from these drugs means that they are subject to additional regulations and good prescribing practice should be followed. NICE guidance on safe prescribing practice recommends that decimal points should be avoided. There should be consideration that palliative care patients often have a significant tablet burden and there is increased risk for error when multiple tablets are needed to supply the prescribed dose. We completed a quality improvement project to improve opiate prescribing and administration safety on the IPU.
Method We created two aide memoire charts to encourage safer prescriptions of opioids. These provided guidance on whole number doses of immediate release (I/R) opioids with corresponding easily measured volumes and doses of modified release (M/R) opioids which could be provided by the smallest number of tablets. We reviewed prescribing practices on the IPU before and after the introduction of each chart and education to the medical team.
Results Prior to the I/R opioid chart introduction 30% of I/R opioid dose prescriptions had an avoidable decimal point and 40% of corresponding volumes were not easily measured. This improved to 6% and 20% respectively after the interventions. Prior to the M/R chart introduction 55% of M/R opioid prescriptions required 2 or more tablets to supply the required dose. After the interventions there was a moderate improvement with 45% requiring 2 or more tablets.
Conclusion There was improvement in I/R and M/R opioid prescribing practice following the introduction of the aide memoire charts and education to the medical team. More education to medical staff around the use of the charts is required to see a continued improvement in prescribing practices on the IPU.
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