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Clinical audit
Better opioid prescribing in an inpatient oncology unit: quality improvement project
  1. Anna Weil1,2,
  2. Shan Shan Vijeratnam1,3,
  3. Valerie Potter1,
  4. Jaymi Teli1 and
  5. David Feuer1,4
  1. 1 Department of Palliative Medicine, St Bartholomew's Hospital, London, UK
  2. 2 Community Palliative Care Team, St Joseph's Hospice, London, UK
  3. 3 Community Palliative Care Team, St Francis Hospice, Romford, UK
  4. 4 Department of Palliative Medicine, Homerton University Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Shan Shan Vijeratnam, St Bartholomew's Hospital, London, London, UK; shan.vijeratnam{at}nhs.net

Abstract

Objectives Unsafe opioid prescribing can lead to significant patient harm and improving standards is a national priority. This report summarises a three-stage process relating to opioid prescribing, which has led to a sustained improvement.

Methods Opioid prescriptions were reviewed retrospectively over a 4-year period in a tertiary cancer centre. The first audit cycle took place in 2017. When repeated in February 2020 following an opioid education programme implementation, prescribing remained poor. In September 2020, a quality improvement project (QIP) was developed with several interventions including opioid prescribing guidelines.

Results The first audit demonstrated that 76% met safe prescribing and 68% best practice. The second audit showed a deterioration in prescribing, 61% met safe prescribing and 39% best practice despite the implementation of an education programme. The QIP has led to an improvement in prescribing, at 4 months, 87% met safe prescribing and 56% best practice.

Conclusions Despite implementation of a medical education initiative, a marked deterioration in safe opioid prescribing occurred. A shift towards QI methodology led to a successful pilot of focused interventions and resulted in improved standards of safe prescribing.

  • service evaluation
  • education and training
  • drug administration

https://doi.org/10.1136/bmjspcare-2021-003477

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    Footnotes

    • Contributors AW is responsible for the overall content as guarantor; AW, JT and DF were in charge of designing and planning of the project. SSV/JT was responsible for leading multi-disciplinary steering group to ensure QIP was carrying out in ward. SSV/JT was responsible for leading the multi-professional steering group. SSV/AW was involved with extracting data and reporting the results. AW, SSV, VP and DF contributed to the planning, outline and first draft a well as editing of paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.