Abstract

Uganda was the first African country to make palliative care part of its National Health Policy, in 1999. But provision remains patchy and consequently the awareness of important palliative care principles among general healthcare staff is also variable. Mbarara Regional Referral Hospital (MRRH) in South-West Uganda has no resident palliative care team, but services are provided by three times-weekly visits from the charity Hospice Africa who prescribe and dispense oral morphine. The hospital pharmacy, despite having access to morphine, has filled no prescriptions for it from hospital clinicians between September 2010 and March 2011. The question was raised whether non-prescribing of morphine reflects deficient knowledge of pain control among medical staff. This audit therefore aimed to explore knowledge and attitudes toward pain control among medical staff in MRRH and then target an intervention to improve awareness. In addition, current analgesia prescribing practices were audited. A questionnaire was distributed to doctors and students within the medical department to assess baseline knowledge against eight audit standards. After an education programme, the questionnaire was then re-distributed to evaluate any change in understanding. In addition, ‘snapshot’ audits of all analgesic prescriptions on the medical wards were conducted before and after the educational intervention. Initial knowledge of analgesia and attitudes towards its use showed deficiencies in a number of areas. These gaps in understanding showed universal improvement after the educational sessions. However, the audit of prescribing demonstrated only a small increase in correct prescriptions over the audit period. These results demonstrate that targeted education was successful in improving physician's knowledge of pain control, however in order to maximise correct prescribing an alternative intervention seems to be required.