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15 Variance in self-reported opioid prescribing practices by junior doctors at a district general hospital: implications for medical education
  1. HK Crispin and
  2. N Heron
  1. West Midlands Deanery, Worcestershire Acute Hospitals Trust


Introduction Opioids are commonly prescribed by Junior Doctors in the acute hospital setting. Here we describe the self-reported behaviour of this professional group in relation to opioid prescribing for palliative in-patients at a District General Hospital.

Method A structured survey was completed by twenty-seven training grade doctors from F1-CT3 (85.2% F1 or F2). The anonymous responses related to self-reported behaviour based on recall of patient care episodes.

Results Two thirds of respondents were involved in the care of palliative patients on a weekly basis. Therefore, the prescribing of opioids and evaluation of treatment efficacy should be embedded into their practice.

When monitoring the side-effects of opioid therapy, patients may not automatically declare these, so it is advisable to directly enquire. Seventy-three percent of respondents reported that they do so for less than half of their patients. Constipation and nausea were reported as most likely to be assessed; being ascertained at least half of the time by ninety-six percent and eighty-five percent of respondents, respectively. None of the respondents routinely enquired about bad dreams, myoclonic jerks or hallucinations.

The occurrence of opioid-associated side effects, or the absence of these, are crucial findings to document in the medical record. Forty-five percent of respondents reported that they do not always document when a patient is experiencing side-effects from opioid therapy. Forty-eight percent of respondents reported that they never document the absence of opioid-associated side effects.

Conclusion This account indicates scope for improvement in the monitoring and documentation of side effects associated with opioid therapy by the Junior Doctors at this District General Hospital. These findings highlight a need for education of this staff group at a local level, and may well indicate a need for enhanced education in opioid prescribing in Medical Undergraduate Curricula.

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