Abstract
Introduction:
Opiates are suitable analgesics in acute pain. However, there is no evidence to support their use in chronic pain and NICE discourages its prescription. Opiates are commonly prescribed amongst the elderly, and long-term use is associated with immunosuppression, hyperalgesia, fractures, falls and dependence. Once opiates are prescribed for acute-on-chronic pain, we should discourage long-term use by ensuring they are reviewed and weaned in the community and that patients are counselled on their risks. We aimed to promote effective opiate weaning practices upon patient discharge.
Methods:
Over 7 months, we reviewed discharge summaries and clinical notes across 3 geriatric wards, looking for patient education and advice given to GPs to review and wean opiates. Along with departmental teaching, we designed two text templates that could be automatically added to discharge summaries by doctors and pharmacists. One text educated patients and the other advised GPs to review opiates.
Results:
Post intervention data for 2 months showed improvements in both outcomes. The monthly percentage of discharge summaries including advice to GPs and patient counselling/education rose from a baseline median of 33% to 83% and 0% to 83% respectively.
Conclusion:
This quality improvement project demonstrates how introducing a text template to discharge summaries improves opiate stewardship and hence patient safety across geriatric wards. Next steps include introducing a patient information leaflet and further work with pharmacy to ensure our intervention’s ongoing use. With the assistance of local GPs we also aim to expand our project to wean opiates that patients were on pre-admission.