Improving Opioid Deprescribing at Hospital Discharge: A Quality Improvement Project

Introduction: Opioid medications are associated with significant side effects in older people, including constipation, falls, delirium, and reduced bone health which can lead to loss of independence and hospital readmission. NICE guidelines encourage appropriate opioid deprescribing and review. This Quality Improvement Project aimed to improve the provision of education and a weaning plan for patients with opioids prescribed at discharge, following an acute hospital admission. 

Method: To achieve this, we provided education of opioid deprescribing to doctors and pharmacists across the Acute Medicine and Care of Older People wards, created proformas to be included in discharge summaries for patients and GPs, and created a patient information leaflet to be included at the point of discharge. Data were collected retrospectively from discharge summaries and TTA prescriptions.

Exclusion criteria were opioids prescribed: in the palliative care setting, for management of cancer-associated pain, and patients with sickle cell anaemia. 

Results: Pre-implementation, 26% of patients discharged with opioids received appropriate education regarding the risks of long-term opioid use and weaning advice. Following doctor and pharmacist education, this increased to 33% in Acute Medicine and 64% in Care of Older People. The proportion of patients discharged with a 14-day opioid supply decreased from 60% at baseline to 50% in Acute Medicine and 54% in Care of Older People.

Conclusions: Planned opioid deprescribing should become routine practice in the hospital discharge process, particularly in the care of older patients. Future cycles will focus on Orthogeriatric services where opioid prescribing following acute fractures is common. Ongoing measures require hospital-wide roll-out of the discharge summary proforma, and publishing Trust deprescribing guidelines. Incorporating opioid-weaning guidance into departmental inductions will aim to make deprescribing a routine part of the transition of care from hospitals to GPs, rather than being dependent on individual prescribers.