Background Opioids can have serious risks and side effects. Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective pain treatment.
Purpose To assess the level of adherence to standard treatment guidelines among clinicians prescribing opioid based therapy for admitted patients.
Material and methods This was a cross sectional study conducted on 23 May 2016 in a tertiary hospital. Electronic prescriptions were analysed. When therapy included opioids, the following data were collected: age, gender, opioid prescription and clinical service. Tramadol was excluded.
‘Prescription adherence to standard treatment guidelines’ was defined as follows: (1) firstline pain therapy should be based on non-opioid analgesics; (2) when prescribing an opioid, it should be checked if another opioid was prescribed to prevent overdose; (3) the first opioid prescribed should be a normal release opioid and at a minimum effective dose; (4) an appropriate rescue opioid should be used. If one of the above conditions was not met, the prescription was classified as ‘non-adherent to standard treatment guidelines’.
Results From a cohort of 1014 admitted patients with electronic prescribing, 100 with opioids were screened. 51 (51%) were men. Median age was 74 (4–99) years. 30 (30%) patients were in the surgical unit, 22 (22%) in internal medicine, 10 (10%) in oncology, 8 (8%) in palliative care, 8 (8%) in geriatrics, 6 (6%) in pneumology and 16 (16%) in ‘other units’. Patients had a mean of 1.35 (SD 0.64) opioids prescribed. As firstline therapy, most common opioids prescribed were parenteral morphine (40; 40%), transdermal fentanyl (32; 32%) and prolonged release oral morphine (13; 13%), and as secondline, parenteral morphine (12; 48%), normal release oral fentanyl (5; 20%) and normal release oral morphine (3; 12%).
20 (20%) opioid prescriptions did not follow standard treatment guidelines: 5/30 (17%) of surgical unit opioid prescriptions, 5/22 (23%) of internal medicine, 2/10 (20%) of oncology, 1/8 (13%) of palliative care, 0/8 of geriatrics, 2/6 (33%) of pneumology and 5/16 (31%) of ‘other units’. Reasons for non-adherent prescriptions were: ‘do not have an non-opioid analgesic therapy prescribed’ (12/20), ‘non appropriate rescue opioid’(1/20), ‘prescription of two different rescue opioids’(4/20) and ‘regular prescription of two different opioids’ (3/20; 43%).
Conclusion Level of adherence to standard treatment guidelines could be considered adequate. Opioid prescriptions in the hospital setting could be improved facilitating access to clinical practice guidelines for opioid therapy to clinicians, especially in clinical services where opioid prescription is not a routine clinical practice.
No conflict of interest
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