P-117 By the clock: audit investigating the administration of regularly prescribed opioid analgesia in palliative patients on general hospital wards

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Abstract

Background and aims

Slow release opioids provide the mainstay of chronic pain control for many palliative patients. To ensure effective pain relief therapeutic levels must be maintained. Opioid pharmacokinetics require regular dosing intervals to achieve this and ensure no unnecessary breakthrough pain. The aim of the audit was to assess whether palliative patients on general hospital wards were receiving opioid doses at the appropriate times.

Method

The audit was carried out across the general wards of the local District General Hospital. Palliative inpatients were identified via the hospital palliative team register. On two occasions two weeks apart all palliative inpatients on regular opioid analgesia were selected. Prescription charts and controlled drug books were used to gather data. Controlled drug book sign out times were used as a proxy for administration times. Outcomes recorded included prescriptions made, time and date doses given, and any doses omitted and reasons documented. Appropriate timing was considered administration within ±30 min prescribed time.

Results

12 patients met the inclusion criteria with 290 opioid doses administered between them. Of these only 19 (6.6%) were given within 30 min of the prescribed time. The majority of these were given late (256 doses, 88.3%). The average time for doses given was 2 hours 10 after the prescribed time. 8 prescribed doses were not given and of these, 2 (25%) had documentation why. 4 out of a total of 28 prescriptions (14.3%) gave an incorrect prescribed time interval.

Recommendations

Staff re-education to ensure timely administration of opioid doses and reiterate the need for documentation of omitted doses, is a priority. Prescribers need reminding of the correct opioid dosing intervals. Prescribers might also consider discussing prescribing times that could make timely nurse administration easier.

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