WTP8.09 Improve prescription rate of combined regular and as required (PRN) analgesia in adult patients on a surgical ward in a DGH

Aims To enhance the rate of appropriate prescriptions of analgesia (combined regular + PRN) for general surgery inpatients to 100%. Methods 7-Day PDSA cycles, statistical process control charting.First intervention: Doctors in the department were reminded of departmental and NICE guidelines.Second intervention: A foundation doctor nominated as QIP lead, checked contemporaneously whether analgesia was prescribed and provided feedback to colleagues.Third intervention: QIP leading a small team, contemporaneously prescribed analgesia not prescribed by admitting teams. Results First intervention: no improvement in analgesia prescriptions. Second intervention: non-significant improvement in combined regular+PRN prescriptions compared with the first intervention (65% vs 85%). Significant decrease in no analgesia prescriptions. Third intervention: No improvement in combined regular+PRN prescriptions. Loss of significant decrease in no analgesia prescriptions. Significant increase in PRN-only prescribed. Third intervention 2x repeat cycles: significant improvement in combined regular+PRN prescriptions, however not sustained. Significant decrease in no analgesia and regular-only prescriptions. PRN-only prescriptions did not decrease significantly. Conclusion The initial intervention was ineffective, likely due to doctor familiarity with local and national guidelines. The implementation of human intervention showed a positive improvement; however, was not sustained potentially due to the loss of feedback in the third cycle. The third intervention repeat cycles showed the best results but did not achieve the goal of 100% due to ongoing PRN-only prescriptions. Moving forward it would be imperative to investigate why there is a PRN-only patient subgroup i.e. day-case patients, over-night admissions, and incorporate ongoing feedback e.g. prescribing prompts to facilitate further improvement.