Audit definition: The National Institute for Health and Clinical Excellence, (NICE), published “The Principles for Best Practice in Clinical Audit in 2002, which defined clinical audit as, “a quality improvement process that seeks to improve patient care and outcomes through a systematic review against explicit criteria and the implementation of change. Aspects of the structure, processes and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team or service level and further monitoring is used to confirm improvement to healthcare delivery.”
https://www.nice.org.uk/media/default/About/what-we-do/Into-practice/principles-for-best-practice-in-clinical-audit.pdf
A brief overview of the context of the audit and why this audit is important. The reader should be clear why you are doing this audit and be signposted to any appropriate literature. (300 words excluding the definition above)
1) What are opioids? What’s the general mechanism of action of opioids?
– Are group of pain-relieving drugs that work by interacting with opioid receptors in your cells
– Example of opioids: oxycodone, hydrocodone, morphine, and methadone.
2) What are the use & benefits of opioids? Opioids are very good analgesics for acute pain and pain at the end of life but there is little evidence that they are helpful for long-term pain. https://www.england.nhs.uk/south/info-professional/safe-use-of-controlled-drugs/opioids/
3) Disadvantages of opioids/ side effects? nausea, vomiting, constipation, pruritus, dizziness, dry mouth and sedation. Side effects are extremely common with opioid therapy. https://fpm.ac.uk/opioids-aware-clinical-use-opioids/side-effects-opioids#:~:text=Most%20common%20side%20effects%20are,extremely%20common%20with%20opioid%20therapy.
4) Explain the importance of opioid auditing?
-opioid has been prescribed more than double in the period 1998 to 2018. This has been referred to as an opioid epidemic in the UK. Audits are used to ensure responsible opioid prescribing by healthcare practitioners
– It is important to provide safe, effective and efficient care to patients.
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30471-1/fulltext
For this audit, 1202 patients were reviewed in this clinical audit. The patients were from a musculoskeletal ward in a hospital.
Please can you answer the questions presented above for the introduction section
Results:
Only a description of the trends/results of each graph graph is required. Description needs to be written below each graph.
Audit standard 1- Line Graph to show the number of opioid prescription prescribed per month between March 2019- February 2020
Month Number of opioid prescriptions prescribed per Month
Mar-19 302
Apr-19 325
May-19 267
Jun-19 246
Jul-19 248
Aug-19 290
Sep-19 289
Oct-19 293
Nov-19 226
Dec-19 221
Jan-20 228
Feb-20 251
Audit Standard 2- A pie chart to show the number of patients on doses less or more than the equivalent of 120mg of morphine per day
Number of patients be on doses LESS than the equivalent of 120 mg of morphine per day (816 patients) (68%)
Number of patients be on doses MORE than the equivalent of 121 mg of morphine per day (386 patients) (32%)
Audit Standard 3- A pie chart to show the number of generic or brand versions of modified release morphine tablets prescribed
2 branded (MST Continus) (11%)
16 generic (Morphine Sulphate Modified Release) (89%)
Discussion (Around 600 words)
The 3 audit standards for this audit are:
1) The ward should show a decreased trend in opioid prescribing over the audit period (March 2019- Feb 2020)
2) 95% of patients should be on doses less than the equivalent of 120 mg of morphine per day (FPM Opioid prescribing guidelines)
3) 100% of doses or morphine modified release tablets are prescribed by brand (SPS Guidelines)
So using the results above, you will need to compare each standard to the corresponding result, in the results section
You are not repeating your results. In this section you are drawing out key themes from the results
-How do the results comply with existing standards? Are they meeting the approved standards or falling short?
– Describe trends from the data provided or from the results such as the number of different opioids prescribed. See below:
-Audit limitations: No data was provided on patients gender, age or ethnicity so a detailed analysis of dose regime/drug prescribed was not possible. Also clinical indication was not provided. Hence, trends/analysis could not be performed
• What are the general implications / recommendations for practice from these results?
• What recommendations would you make to improve the audit methodology, improve practice and re-audit? Look at the standards and the results. Look at limitations -What are the key take-home messages from your audit results?
References
– Harvard referencing required
Refrences , charts, tables are not included in the word count
