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.
Clinical indication recorded
CSCI dose ranges prescribed (outpatients only)
Appropriate doses and drug combinations prescribed
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.
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