Opioid prescribing: reducing errors and improving patient care

Quality Improvement Poster Download

Background & Problem

Pain is a common symptom for hospital patients. Safe and effective analgesia is a vital part of good clinical care. However, opioid prescribing is recognised as complex and errors are common. After a number of reported adverse incidents relating to errors in the prescription of opioids we wanted to improve the accuracy of opioid prescribing by junior doctors within the trust.

Aim

By April 2017 at least 50% of F1 and F2 doctors within the trust should be able to correctly answer 3 common opioid prescribing questions at a level that would be expected of a junior doctor.

Method

Pre intervention:

A cohort of F1 and F2 doctors were asked to anonymously complete a questionnaire containing 3 common opioid prescribing calculations using any resources that they might normally refer to in their clinical practice (e.g BNF).

The Intervention:

We designed an opioid conversion tool. The goal was for it to be accurate but straightforward to use. The tool was in line with BNF guidance and approved by pharmacy. The tool allows the user to convert any opioid (via any route) to an equivalent dose of another opioid (via any route) by simplifying the relevant conversion ratios. The opioid conversion tool was uploaded to the intranet guidelines and released in the pharmacy update. Printed versions in the form of an ‘aide memoire’ card were distributed to F1 and F2 doctors and incorporated into the foundation programme teaching.

Post Intervention:

Re audit using same questionnaire of the current F1 and F2 doctors.

Results

The project was a success and we achieved our SMART Aim*

96% of respondents had encountered the new guidance
63% stated they used the opioid conversion tool regularly in their clinical practice

Pre Intervention: 7% could correctly answer all 3 opioid calculations
*Post intervention: 70% could correctly answer all 3 opioid calculations

Pre Intervention: 52% got all 3 calculations wrong
Post Intervention: 11% got all 3 calculations wrong

Implications

We plan to build this success by introducing the tool at the new foundation doctors’ induction in the Summer. We are also exploring whether the tool may help in a primary care setting with an initial audit.