The prevalence of pain in advanced cancer is 70 to 90%. Some cancer patients may have more than one pain.The available evidence demonstrates that the efficacy and tolerability of morphine sulphate, oxycodone, hydromorphone and methadone are equivalent.

The aim of this audit was to review the prescribing practice of opioids to palliative patients on the oncology day ward.The nursing and medical staffs were educated frequently with short, interactive teaching sessions.As well as this, an opioid constipation leaflet has been developed and introduced for patient education purposes.This was a re-audit of the audit completed in 2018.

NICE Opioids in Palliative Care Clinical Guideline 140 and Pharmacological Management of Cancer Pain in Adults, National Clinical Guideline No.9, November 2015.

This was prospective re-audit and twenty people were included on the audit. Sixty-five percent were male and 35% were female. All were reviewed by the Palliative Medicine Consultant.

In regards to breakthrough analgesia (BTA), 15 percent of patients did not have breakthrough analgesia prescribed. It has been recommended that the BTA should be 1/6 the the 24 hour sustained release dose. Of those that had breakthrough analgesia prescribed, 83% were prescribed the correct dose of BTA and 17% were not.This is an improvement from last year where only 55% of patients were prescribed the correct dose of BTA.

In the last audit, it was found that laxatives were not prescribed concomitantly with opioids in 40% of cases. On re-audit, the prescribing of laxatives with the prescribing of opioids improved. Laxatives were prescribed in 85% (17/20) of cases.

This re-audit has shown that correct dose of breakthrough analgesia is being prescribed and the corresponding short-acting opioid is being prescribed, i.e. Oramorph with MST. The concomitant prescribing of laxatives have improved also.