Background When strong opioids are initiated for pain in patients receiving palliative care, practice varies. As a result, there is a risk that patients will receive either sub-therapeutic or potentially toxic doses of opioids. Choice of formulation is important from a patient concordance and cost perspective. In May 2012, the National Institute for Health and Clinical Excellence (NICE) published guidelines on initiating strong opioids for adults with advanced and progressive disease (‘Opioids in palliative care: safe and effective prescribing of strong opioids for pain in palliative care of adults’). We reviewed the prescribing practice on hospital wards and assessed our compliance with the guidance and considered the barriers to compliance.

Aim To assess compliance with NICE guidance when initiating strong opioids for pain in adults with a life-limiting illness.

Methods We identified 20 patients with a life limiting illness and that were initiated on strong opioids for pain during their current hospital admission. We reviewed the medical notes and prescriptions measuring prescribing practice against 10 standards outlined by NICE. The patients were from 12 wards including medical and surgical wards. The data was collected over three months.

Results Out of the 10 standards, compliance was 100% in three standards, 50% or above in six standards, and less than 50% in one standard.

Conclusions The results highlighted areas for improvement. The main barrier appeared to be lack of awareness of the guidance. Due to the high turnover of medical staff, continued education is crucial. We have developed an e-learning module, highlighting the guidance, which will be part of the Trust’s mandatory training. The Trust is implementing electronic prescribing and endeavours to include alerts when opioids are prescribed to encourage compliance. With improved compliance, prescribing practice will be safer and the management of pain in our patients will be more effective.