Case study:

24 September 2007

Quality of analgesic prescribing for breakthrough pain in patients taking long-acting opioids

Key points

New guidelines and training programmes have been introduced after an audit in one acute hospital, to investigate opioid prescribing for breakthrough pain in line with established international guidelines and compare prescribing in an acute hospital and a hospice settings.

The study was conducted using patients’ drug charts.In the acute hospital, it focused on all inpatients prescribed long acting opioid analgesics using Control Drugs records, including morphine, oxycodone and fentanyl.

Data was collected prospectively every week on all acute hospital wards as well as a 25-bed hospice inpatient unit.

The study highlighted a number of areas in the acute setting which required review and further training.

As a result of the findings opioid prescribing is now part of nurses’ mandatory training and has a regular teaching slot on all junior doctors’ programmes in acute settings.

In addition a quick reference wall chart is on every controlled drug cupboard and new guidelines have been developed in conjunction with the acute pain service and pharmacy.

In the light of the study it is planned to put trust guidelines on the intranet and to include quick reference charts in all junior doctor induction packs.

In addition pain management is to be prioritised in third and fifth year medical student teaching.

Work still has to be done to dispel myths that, for instance, opioids expedite death or cause distressing side effects.

Challenges to maintaining good practice can be that some staff remain unconfident about prescribing and are unclear of the indications for use or the dose conversion between differing routes for administration.