Introduction The number of people requiring palliative care is increasing with an aging, co-morbid population. Pain is a prevalent symptom for palliative care patients and is often managed with opioids. Opioids reduce reaction time and can cause drowsiness and visual disturbance. Evidence recommends that driving should be avoided until a stable dose of opioids has been reached. It is vital for patient and public safety that these facts are communicated to patients who are prescribed opioids, as well as the legal consequences if guidance isn’t followed. These discussions facilitate joint decisions, optimising patient freedom and quality of life. Surprisingly though these important discussions around driving and opioids don’t always occur, and so this project sought to develop a systematic approach to integrating them into practice.
Design Retrospective case note analysis and prospective interventional quality improvement study.
Setting A 16 bedded specialist palliative care inpatient unit.
Population Hospice inpatients with an ECOG performance score of zero to three who had been prescribed opioids.
Intervention Three Plan-Do-Study-Act (PDSA) cycles were performed. Firstly, the issue was discussed in the daily multidisciplinary team meeting (MDT) to raise awareness, secondly a prompt was added to a pre-existing clerking proforma. Finally, a reminder poster was placed in the ward office to promote discussion prior to discharge.
Outcome Measures Primary measures were the proportion of patients with the presence of documented driving status, and the presence of a documented discussion surrounding driving and opioids.
Results Baseline data found that 11.5% of patients had a documented driving status and 11.5% had a documented discussion surrounding driving and opioids. Over the course of the study the proportion improved to 65.2% and 60.9% respectively.
Conclusion Use of Quality improvement change methods have resulted in the successful integration of new interventions to increase discussions around driving when prescribed opioids. A previously overlooked issue in this facility, thus improving clinical and patient information sharing, and patient empowerment to take charge of their own health.
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