The 2012 NICE guidelines on prescribing strong opioids cover prescribing in advanced disease. The aims of our audit were to demonstrate compliance with these guidelines at The Mid Yorkshire Hospitals NHS Trust (MYHT).
A prospective audit was undertaken and data collected from 97 patients who had been started on strong opioids across MYHT. Patients included were those reviewed by the hospital and community Specialist Palliative Care Team (SPCT) and inpatients on both respiratory and oncology wards. Patients reviewed by the SPCT team were identified using the weekly patient MDT list and further information found using SystemOne. Hospital inpatients were identified using the controlled drug books and cross referencing with medical notes.
48% of patients were initiated on a strong opioid without having previously been on a weak opioid. Information giving was poor with only 0%–20% of the audited patients being informed about specific matters documented in the NICE guidelines, including advice regarding drowsiness and driving. Disappointingly, only 42% of patients commenced on a strong opioid were also prescribed a laxative. Prescribing in renal impairment was not fully in line with NICE guidance suggesting consultation with a specialist if moderate to severe impairment present – in 4/6 cases where inpatients (excluding those reviewed by the SPCT) had an eGFR of <30 no specialist input was sought.
Limitations of the audit include that a relatively small data set was collected from each clinical area. In addition, the audit relied on healthcare professionals formally documenting decision making and discussions with patients in the notes.
Recommendations include sharing the results with the audited specialities and specific education regarding the benefits of using a trust-wide opioid leaflet to assist with information giving. A quality improvement project focusing on improving co-prescribing laxatives was subsequently undertaken within the respiratory department.