Introduction The Medical Gastroenterology Ward in our District General Hospital was identified as a relatively high prescriber of intravenous (IV) and oral opiate analgesia, and intravenous and oral cyclizine, compared to other wards. This was in the context of a cohort of challenging patients with nonspecific abdominal pain and unexplained medical symptoms (UMS). A strategy to define the problem and manage opiate use for non-malignant pain was developed then evaluated.
Method Intravenous (IV) and oral use of opiates on each of the Medical wards of our hospital was measured, in units of oral morphine equivalent (OME), as well as cyclizine. A multidisciplinary group was formed comprising a Consultant Anaesthetist/Pain Management Specialist, Liaison Psychiatry, Clinical Psychology, Pharmacy. The team based approach to restricting opiate use in frequent attenders, or UMS patients included education of medical and nursing staff around opiate awareness, an opiate policy with guidance for maximum 48 hour IV opiate use before non parenteral use, care management plans, and development of an early warning system from our information analyst in Pharmacy to identify patients on IV morphine for 48 hours to cue discussion between the Pain team and the treating Physician.
Results The Medical Gastroenterology ward was an outlier in terms of prescription of high total doses of IV morphine and oral morphine or oral morphine equivalent (OME). Comparing 2015 and 2016, The Gastroenterology ward achieved a reduction in oral (or OME) and IV morphine use of 44% and 75% respectively. Over th esame time period, these values were unchanged for the other 5 Medical wards, excpet the MAU wherer oral and IV morphine prescription fell by 9% and 41% respectively. This may have included similar patients with nonspecific abdominal pain or UMS. Cyclizine prescription remained high no reduction in IV use. REduction in opiate use in Gastroenterology was not associated with any reduction in length of stay.
Conclusion A team based comprehensive pain management stategy targeted at a Medical Gastroenterology ward coincided with a dramatic reduction in intravenous opiate use, whilst there was no corresponding trend on other Medical wards. We propose to expand the strategy to patients with non-specific abdominal pain and undiagnosed medical symptoms requiring opiate analgesia. We also plan to embed opiate management in a wider program of managing UMS, and opate use in Primary Care.
Disclosure of Interest None Declared
- pain management
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