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Abstract
Background The Gosport Report has highlighted the importance of maintaining appropriate opioid and sedative use in palliative care, ensuring transparency, and demonstrating safe and effective prescribing. Comparing prescribing practices of organisations providing services to similar cohorts of patients is one way of achieving this. A local collaborative project by geographically neighbouring hospices used a common data collection sheet to compare across organisations and commissioning boundaries, to assess regional consistency in opioid and sedative prescribing at EoL.
Method This review of practice involved using an existing data collection sheet (from a different commissioning area) within two hospices (SWH, SMH) to facilitate a retrospective, case-note review of randomly selected inpatients unit deaths over 12 months. Data from those hospices, and 7 others in the wider region, was collated and shared by one coordinating organisation.
Results Both SWH and SMH had clear documentation that the patient was dying, 87%(SMH) and 94%(SWH), with the indication and use of syringe pumps being clearly documented, 88%(SMH) and 94%(SWH.) The IQR of median doses for morphine were 30.5 – 51.25, SMH median value [35] is within IQR and SWH median value [15] is below IQR. The IQR of median doses for midazolam were IQR of median doses is 10.75 – 15, SMH median value [8] is below IQR and median value [13] is within IQR.
Conclusion Comparison of data from hospices within the region has allowed each organisation to critically look at their opioid prescribing compared to practice in similar organisations across Kent, Surrey, and Sussex. This project demonstrates an example of how the Gosport Report recommendation to annually review opioid and sedative medication prescribing in EoL can be facilitated. Including comparison of outcome measures to assess prescribing effectiveness is a proposed future development.