Introduction
UK data shows discharge amounts of opioids may exceed patient needs. This could lead to dependence, addiction, an unnecessary amount of opioid tablets in the community and increased cost.
Methods
For each cycle, patients discharged from the day surgery unit (DSU) over a period of 2 days were assessed. Data was collected 1 month post-operatively from electronic notes. In cycles 2 and 3, a patient survey was conducted. Cycle 1 assessed the prescribing practices and opioid use. Cycles 2 and 3 assessed patient experience of discharge analgesia. The interventions between cycles 2 and 3 were decreasing the discharge pack of dihydrocodeine from 28 to 14 tablets and asking the DSU nurses to give patients written advice about pain relief and verbal advice on disposal of excess medication.
Results
Most patients discharged were prescribed opioids, predominantly dihydrocodeine. In Cycle 1, over 80% did not collect a repeat prescription. Patient satisfaction was similar before and after interventions (74% vs 85%) but excess dihydrocodeine was reduced by 80%. Twice as many patients received information about pain relief (26% vs 55%) and excess medication (5% vs 10%).
Conclusions
We have successfully decreased the number of dihydrocodeine tablets dispensed on discharge while maintaining adequate analgesia, reducing the potential for drug diversion and saving money. Written information given to patients doubled, but only a small percentage received information about disposal of excess medications. Next steps are to update the patient information leaflets and ask staff to routinely discuss disposal of excess medications.
Authors
Nicola Rodgers
Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
Amanda Bull
Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
Catherine Collinson
Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
Claire Morrison
Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
Janet Nicholson
Royal Infirmary of Edinburgh, Edinburgh, United Kingdom