Background In a recent spate of referrals regarding pain control we found constipation was the major issue. This prompted us to question the commonality of this, as assessing and managing pain are core medical skills which, if done inadequately, can result in incorrect/inappropriate patient management.
Opioids, an important part of pain management, are widely used, by all doctors. The common side effects are well recognised. There are several different opioids, all of which can cause temporary nausea/vomiting and persistent issues with constipation. Prescribing errors are not uncommon. Thus we conducted an in-patient, Trust-wide spot audit of drug charts for prevalence of opioid prescribing, and anticipation of common side effects.
Method All adult care (non-ITU) wards were visited, drug charts reviewed and spreadsheet data collection tool populated.
Results In total, 782 charts were assessed – 440 (56%) included an opioid.
Morphine was commonest, 55%, codeine 32%, oxycodone 4%, fentanyl 3%, buprenorphine, methadone and tramadol 2% each, dihydrocodeine 1%, one prescription each for pethidine and alfentanil.
Of the prescriptions, 229 were for ‘regular’ opioids and 418 ‘as needed’ – 28 (4%) of these did not specify frequency of opioid use.
Bowel habit was recorded on 69% of the charts. At least one laxative was prescribed on 267 charts (61%), totalling 450 prescriptions – senna 176 prescriptions, lactulose 144, macrogol 77, docusate 31, glycerine suppositories 11, six phosphate enemas and one for naloxegol.
Conclusions Appropriately used, opioids are invaluable for managing pain, but cause well recognised common side effects of which constipation can cause the greatest pain, distress and misery for our patients. It’s relatively straightforward to manage, but needs to be anticipated, monitored for and addressed effectively to minimise patients suffering because we aren’t questioning and recognising symptoms for what they are and prescribing correctly. More education planned.
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