Background The urgent need to improve patient safety with regards to opioid prescribing on the specialist oncology inpatient wards at St Bartholomew’s Hospital was highlighted in an audit conducted by the hospital palliative care team in 2017. This demonstrated multiple opioid prescribing and administration errors, including for transdermal patches. The introduction of an opioid patch monitoring chart, as well as a robust education programme for all clinical staff, was recommended.
Errors relating to transdermal patches often include: new patches being applied prior to old ones being removed, failure to recognise patches falling off/becoming displaced and multiple different opioid patches being applied in different locations. Through regular documented nursing checks on an opioid patch monitoring chart it would be hoped that these errors could be avoided, as well as improving knowledge and competency around opioid prescribing.
Methods A consultation was held amongst the palliative care and oncology teams regarding the introduction of the chart. An existing chart was adapted with appropriate permissions. The chart was implemented in June 2018 with extensive teaching sessions provided.
Results A prospective audit of the chart’s use was conducted and feedback obtained from users. The results demonstrated that the chart was well used. Only one patient prescribed an opioid patch did not have the appropriate chart in their notes and in only one circumstance was the chart completed incorrectly.
81.8% of surveyed staff found the chart ‘very easy’ to use and 100% felt that the chart improved patient safety.
Conclusions The opioid patch monitoring chart has been well imbedded into the oncology wards. It is now planned to introduce it across the rest of Barts Health NHS Trust.
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