Background The IPU team experienced difficulties regulating the use of buccal fentanyl in a small number of patients.
Methods A review of notes and medication charts in all patients prescribed buccal fentanyl on IPU June 2015–6 was done to ascertain whether it was being prescribed appropriately and whether there were any risk factors for ‘concerning use’.
18 patients were identified. All had a clear rationale for receiving buccal fentanyl.
11/18 patients found it clearly effective; of the remaining 7, 5 ‘sometimes’ found it effective.
5/18 patients showed what we defined as ‘concerning use’ – i.e. they were using it more than qds, using it to toxicity, were extremely unwilling to reduce usage or try other options, used it covertly or admitted to using it for reasons other than pain.
4/18 had risk factors for addiction. 3 of these 4 patients showed ‘concerning use’.
9/18 patients were discharged on buccal fentanyl; there was scope for improvement in the quality of discharge instructions as to how the patient should use buccal fentanyl.
Conclusions 5/18 patients (28%) were felt to have ‘concerning use’ of buccal fentanyl. 3 of these had clear risk factors for addiction this that were identified on admission. Since the time of data collection, the manufacturers have produced a guide for healthcare professionals that includes standardised screening tests for assessing the risk for potential opioid abuse in patients with breakthrough pain. Routine use of these should be considered, with clear explanation of risks shared with all patients, but particularly those with pre-existing risk factors. Patients discharged on buccal fentanyl should be discussed with the GP and have a clear plan on the discharge letter as to the dose, frequency, and type of pain that this is to be used for, along with the rationale.
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