Evaluating the Safety of Opioid Prescribing in Older Inpatients: A Quality Improvement Project.

Introduction.

Opioids are commonly prescribed to older adults but are associated with important adverse effects, including constipation, delirium, sedation, falls, respiratory depression and toxicity, particularly in patients with renal impairment. This quality improvement project assessed the safety and appropriateness of opioid prescribing among older inpatients.

Methods.

A prospective review was undertaken over four weeks across Newington and McDonald wards at Conquest Hospital, East Sussex Healthcare NHS Trust. Thirty inpatients aged ≥65 years who were prescribed an opioid were included; patients receiving end-of-life or palliative care were excluded. Electronic prescribing records and clinical notes were reviewed to assess documentation of opioid indication, co-prescription of laxatives with regular opioids, appropriate opioid selection or dose adjustment in patients with creatinine clearance <30 mL/min, and cautious prescribing in patients with delirium, dementia or cognitive impairment. Compliance was compared with predefined standards.

Results.

The indication for opioid therapy was documented in 19/30 patients (63.3%), compared with a target of 90%. Appropriate laxative co-prescription was identified in 16/30 patients (53.3%), against a target of 95%. Among patients with renal impairment, only 1/6 (16.7%) received an appropriate opioid or had documented dose adjustment. In patients with delirium, dementia or cognitive impairment, evidence of appropriate cautious prescribing was identified in 2/11 cases (18.2%). Morphine was the most frequently prescribed opioid, accounting for 14/30 prescriptions (46.7%).

Conclusion.

This project identified important gaps in opioid prescribing safety, particularly among patients with renal or cognitive impairment. Planned interventions include targeted education, prescribing checklists, ward reminder posters and a concise renal opioid prescribing guide. A re-audit is planned within 3–6 months to evaluate whether these measures improve documentation, laxative co-prescription and patient-specific opioid selection.