OPIOID PATHWAY IN CHRONIC NON-MALIGNANT PAIN
REDUCING THE RISK AND IMPROVING THE BENEFIT
C. Waters.,H. Riggs., A. Morris.,D Pretty., R. Munglani., M. Schofield.,L Jeynes.
Department of Pain Medicine, WestSuffolkHospital NHS Trust
Background
In 2005 universal recommendations in opioid prescribing for chronic non-malignantpain (CNMP) were suggested (Gourlay 2005). In 2010 the British Pain Society published revised guidance on prescribing of opioids in persistent pain. These recommendations and guidelinesprovided a useful framework to establish and incorporate locally agreed standards for clinical practice within a pathway for chronic opioid therapy (COT).
Key components of the pathway include the use of opioid screening and monitoring tools, standardised patient information, both written consent and agreement documentation alongside goal setting. The pathway is led by pain clinicians and co-ordinated by clinical nurse specialists.
The aim of this retrospective audit was to review electronic records of patients who have attended the opioid clinic at the West Suffolk Hospital (WSH) to i) review standards for documented clinical practice and ii) to identify any aspect of care that could be improved upon.
Methods
Anaudit was undertaken after the introduction of an opioid pathway to determine compliance with the following audit indicators:
- All patients will have a diagnosisor an appropriate differential diagnosis.
- Screening for risk of addictive disorders undertaken prior to initiation.
- Written and signed informed consent to the use of opioids obtained prior to initiation.
- Written and signed treatment agreement to the use of opioids obtained prior to initiation.
- Pain level and function are assessed and documented before the start of treatment.
- Patients are provided with an appropriate trial of opioid therapy.
- Pain level and function are regularly assessed.
- The four As of pain medicine regularly assessed (analgesia, activities, adverse effects and aberrant drug-related behaviors).
- Periodically pain diagnoses and co morbid condition reviewed.
- Careful monitoring of prescribing evident.
- For high risk patients secondary monitoring in place.
Results
70electronic records of patients who had attended the opioid clinic at the WSH were reviewed. For all the above indicators the required locally agreed standard was 100%. Results demonstrated mainly excellent compliance for audit indictors with all results varying between 96-100%.
Conclusion
Early results demonstrate excellent compliance with the locally agreed standards.
These findings suggest that an agreed opioid pathway influences good clinical practice in relation to opioid prescribing in CNMP. Following the implementation of a pathway for COT we have observed an improvement in risk assessment and risk stratification, informed consent and agreement as well as improved monitoring. We feel that a pathway offers an opportunity to reduce risks whilst maximising the benefit of opioid therapy.