54 Opioid e-prescribing: adherence to safe and best practice criteria in a tertiary and an acute hospital

Background Unsafe prescribing of opioids can lead to significant harm to patients. A previous report identified improvement in safe practice prescribing following implementation of several interventions using quality improvement methodology. Our aim was to re-audit opioid prescribing practice following the introduction of a new e-prescribing system across the Trust. Methods Opioid prescriptions at a tertiary cancer centre and acute hospital were reviewed against 'safe prescribing criteria' and 'best practice criteria' over three days. This criteria was formulated for the previous studies and are not national standards. Results Safe prescribing adherence fell from 84% to 69% and best practice adherence improved from 33% to 41%. The sole reason for poor adherence to safe prescribing criteria was that there was no facility to document neither the preparation (immediate-release or modified-release) or the strength. We also found that 33% of patients did not have a regular laxative prescribed and 44% did not have an anti-emetic prescribed. Conclusions The introduction of e-prescribing has led to improvements in opioid prescribing: correct drug name, correct dose unit, correct frequency of prescription and automatic e-signatures and date. However, we also identified issues with e-prescribing in particular the inability to document the preparation and strength of liquid opioids. The clinical relevance of this is uncertain and further work is needed to look at whether this would contribute to drug error or patient harm. We also found ongoing issues with lack of anti-emetic and regular laxative co-prescribing. Although, e-prescribing has been largely helpful in ensuring opioids are prescribed safely, we have demonstrated that there is still a need for specific opioid prescribing teaching, pharmacists involvement in checking prescriptions and ongoing quality improvement.