Abstract
Aim: To achieve compliance in > 90% of patients with the NHS Lothian protocol for 'Management of MSK pain in frail elderly’.
Background: NHS Lothian Medicine of the Elderly Department expenditure review showed a 3-fold rise in Lidocaine 5% patch costs the last year. Lack of adherence to the protocol and monitoring of patches prescriptions’ effectiveness felt to contribute.
Methods: A doctors’ team with pharmacy support reviewed expenditure report from April 2023 to April 2024. A prescribers’ survey was sent to evaluate current practises, and another one to nursing staff who administer patches via electronic patient prescribing. PDSA 1 was departmental education based on survey results. PDSA 2 was a focused educational session on MSK protocol and use of the lidocaine patch monitoring form.
Results: 80% of prescribers used lidocaine before prescribing opiates to avoid adverse effects of opiates. Nurses felt prescriptions were sometimes unclear about application site. 5 patients admitted on lidocaine by GP in May 2024 compared to 3 in September 2024. 13 patients were prescribed lidocaine patches in May 2024 compared to 5 in September 2024 following 2 PDSA cycles. No monitoring forms were used.
Conclusion: The use of lidocaine patches reduced following 2 PDSA. It was harder to challenge the use of patches in patients already with GP prescription. Majority of cases lacking adherence to the protocol. The monitoring form was reviewed and felt not to be suitable for all prescriptions. PDSA 3 will focus on modifying this form to ensure suitability.