Optimizing Opioid Prescriptions in Geriatric Populations at Nottingham University Hospitals Foundation Trust (NUH)

• Published in: Age and ageing Vol. 53; no. Supplement_4
• Main Authors: Ali, Haider, Venkatesh, Hari
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 29-09-2024; Oxford Publishing Limited (England)
• Subjects: Aging; Analgesia; Antiemetics; Clinical outcomes; Clinical practice guidelines; Data collection; Elder care; Emetics; Geriatric hospitals; Geriatrics; Health care; Hospitalization; Intervention; Laxatives; Morphine; Multidisciplinary teams; Narcotics; National guidelines; Nurses; Older people; Opioids; Oxycodone; Pain; Pain perception; Patients; Pharmacists; Phenotypes; Prescribing; Prescription drugs; Quality control; Quality management; Trust hospitals
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afae178.146

Abstract
Background
Severe pain is associated with adverse outcomes in the geriatric populations (Ref -Pain and Mortality in Older Adults: The Influence of Pain Phenotype - PubMed (nih.gov)).
Currently it is recommended in local and national guidelines (Ref -Guidance on the management of pain in older people | Age and Ageing | Oxford Academic (oup.com), Clinical Guidelines Policy (koha-ptfs.co.uk)) that the following be implemented to geriatric patients being prescribed strong opioid medication
1) That the correct type of strong opioid medication be prescribed (e.g. oxycodone for patients more than 70 years of age, or for patients with eGFR <50ml/min/1.73m2).
2) To ensure an appropriate review (48-72hrs post-prescription) is in place after acute strong opioid prescription
3) Co-prescription of adjunct Laxatives and Anti-Emetics alongside prescription of any strong opioids
Methods
A multi-disciplinary team involving doctors, pharmacists, nurses and the NUH quality improvement team was involved in all aspects of this project. Initial data collection was done between 1st August 2023 to 1st March 2024. We intend to carry out further data collection between April and August 2024 after our proposed interventions. Data collection was carried out using the EPMA prescribing platform.
Results
Data collected from 1st August 2023 to 1st March 2024 only 70% of patients in health care of the elderly (HCOE) wards had correctly prescribed oxycodone as their strong opioid analgesia. It was noted that 37% of HCOE patients have had morphine incorrectly prescribed at least once during their admission. Only 11% of strong opioid prescriptions on HCOE wards in NUH had a review scheduled. A. Whilst 73% of patients had laxatives co-prescribed only 25% had anti-emetics co-prescribed.
Conclusion
From our initial results there is an obvious need for improvement in terms of guideline adherence. We will aim to collect further data and we will put into place interventions in a ‘PDSA’ manner to improve this.