Morphine is the recommended first line opioid by NICE for severe pain. However, many patients on the Hospice in the Weald ward were noted to be on alternative opioids such as Oxycodone and Fentanyl. The reason for choosing an alternative opioid was not always clear. It is accepted practice that oxycodone is a suitable alternative for those who develop adverse effects with morphine that are not controlled by usual measures and Fentanyl and Alfentanil are suitable with poor renal function.Aims
This audit aimed to identify if prescribing of opioids in IPU followed both NICE and local guidelines.Methods
This prospective audit ran over a 6 week period during November and December 2015. Once a patient had been identified as being prescribed an alternative opioid information was obtained by talking to the patient or relatives if appropriate and/or looking through paper notes, electronic entries, telephoning GP surgeries or community pharmacies.Results
38 patients were admitted to IPU during the audit period of whom 47% were prescribed an alternative opioid. The most common reasons for switching a patient to an alternative opioid were due to renal function (33%) or patient being intolerant of morphine (39%). The most commonly reported side effect leading to a change in opioid was hallucinations and in 71% of all cases a decreased dose of medication was tried before switching opioids. 72% of switches to an alternative opioid were deemed appropriate according to NICE and local guidelines.Conclusions
Although alternative opioids are frequently prescribed on IPU, the majority of prescribing is appropriate according to NICE and local guidelines. Improvements could be made in documenting in the electronic notes the reason an alternative opioid was prescribed, side effects experienced and whether a reduced dose or supportive medication was tried first.