Background A large proportion of the UK population have been diagnosed with progressive, chronic diseases resulting in pain. Potentially requiring strong opioids which are often prescribed in primary care (National Collaborating Centre for Cancer, 2012). Concerns about adverse effects, confusion about which opioid to prescribe and the wide array of available options may result in undertreated pain or increased risk of adverse effects (National Collaborating Centre for Cancer, 2012). The National Collaborating Centre for Cancer has developed guidelines for NICE to clarify the pathway for initiation of strong opioids in palliative care patients.
Aims To identify all patients in the practice population with progressive disease, specifically: Cancer, CKD 3/4, Heart Failure, Liver Failure, COPD who were initiated on a strong opioid and to investigate if prescribing practice and management was compliant with NICE guidance.
Method Standards based audit undertaken in a London General Practice. Data collection by foundation year 2 doctor. EMIS searches by practice IT manager with retrospective identification of patients coded as chronic kidney disease, COPD, heart failure, liver failure, cancer and initiated on a strong opioid before or on 31.12.2017, review of consultation notes to identify prescribing practice and referral if appropriate. Comparison against standards outlined in NICE ‘Clinical audit tool : initiating drug treatment’ and data collection sheet, data input into Microsoft Excel.
Results 33 patients identified for inclusion. 48% patients initiated appropriate initial strong opioid. Only 13% of patients with renal or hepatic failure were discussed with a specialist, 10% of patients were prescribed immediate release oral morphine for breakthrough pain and 21% of patients were prescribed laxatives.
Conclusions This audit has identified discrepancies between prescribing and referral practice and the guidelines, which could result in poor patient management and risk of adverse effects. The findings of this audit were presented in a practice meeting accompanied by teaching and distribution of the guidelines. A re-audit is due to be undertaken in 2020.
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