Background The Gosport Independent Panel found lives had been shortened over an 11-year period at Gosport Memorial Hospital due to high or inappropriately prescribed opioids. Recommendations for safe prescribing of opioids via continuous subcutaneous infusions (CSCI) were implemented as a result. Symptom control and palliative care team (SCPCT) conducted an audit evaluating all CSCI with opioids or sedatives prescribed for inpatients and on discharge within a Specialist Cancer centre to ensure they met the standards set by the Gosport Panel.

Standards:

• Clinical indication recorded

• CSCI dose ranges prescribed (outpatients only)

• Appropriate doses and drug combinations prescribed

Trust standards:

• Anticipatory ranges for discharge discussed with SPCT

• No inpatient ranges

• Prescribing opioids within trust guidelines

Method Prospective audit of inpatients with CSCI containing opioids or sedatives over an 8-week period, identified from SCPCT or pharmacy dispensing records.

Results 28 inpatients received strong opioids for pain (morphine n=17, oxycodone n=8, alfentanil n=3) and 4/28 (14%) patients were prescribed sedatives for terminal agitation. The doses prescribed were appropriate for the clinical situation except in one case where a higher opioid dose was prescribed without discussing with SCPCT. Most patients (22/28, 78%) had a dose titration in line with their changing clinical condition. Doses were increased by 30–50% (n=22), <30% (n=2), and > 50% (n=2). 4 patients were discharged with pan-London MAAR charts for anticipatory CSCI and subcutaneous PRNs. 1/4 had a dose range prescribed by SCPCT. All charts had appropriate clinical indications for prescribed opioids and sedatives, however PRNs were prescribed with a shorter interval than recommended within guidelines.

Conclusions All inpatients were prescribed appropriate doses of CSCI opioids and sedatives for their clinical indication in line with Gosport recommendations. 30–50% dose titration was common but within the highlighted standards. Improvement in discharge prescription for PRN medication was highlighted & fed back to prescribers.