Objectives Unsafe opioid prescribing can lead to significant patient harm and improving standards is a national priority. This report summarises a three-stage process relating to opioid prescribing, which has led to a sustained improvement.

Methods Opioid prescriptions were reviewed retrospectively over a 4-year period in a tertiary cancer centre. The first audit cycle took place in 2017. When repeated in February 2020 following an opioid education programme implementation, prescribing remained poor. In September 2020, a quality improvement project (QIP) was developed with several interventions including opioid prescribing guidelines.

Results The first audit demonstrated that 76% met safe prescribing and 68% best practice. The second audit showed a deterioration in prescribing, 61% met safe prescribing and 39% best practice despite the implementation of an education programme. The QIP has led to an improvement in prescribing, at 4 months, 87% met safe prescribing and 56% best practice.

Conclusions Despite implementation of a medical education initiative, a marked deterioration in safe opioid prescribing occurred. A shift towards QI methodology led to a successful pilot of focused interventions and resulted in improved standards of safe prescribing.