Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

scholarly journals An organizational perspective on the long-term sustainability of a nursing best practice guidelines program: a case study

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Andrea R. Fleiszer ◽  
Sonia E. Semenic ◽  
Judith A. Ritchie ◽  
Marie-Claire Richer ◽  
Jean-Louis Denis
Keyword(s):  
Practice Guidelines ◽  
Best Practice ◽  
Best Practice Guidelines ◽  
Organizational Perspective

The role of long-term site productivity in maintaining healthy ecosystems: A prerequisite of ecosystem management

1997 ◽  
Vol 73 (6) ◽  
pp. 731-740 ◽  
Author(s):  
Dave M. Morris
Keyword(s):  
Organic Matter ◽  
Forest Management ◽  
Practice Guidelines ◽  
Best Practice ◽  
Forest Health ◽  
Site Productivity ◽  
Nutrient Pool ◽  
Criteria And Indicators ◽  
Best Practice Guidelines

Forest health is a central issue across North America. Most definitions imply that forest health is a condition of the forest ecosystem which sustains complexity or diversity while still providing for human needs. Imbedded in this definition is the need to maintain the productive capacity of managed sites. Although site productivity is largely a function of climate, soil properties, and the biotic potential of the vegetation occupying the site, forest management can also play an influential role in altering site productivity.In terms of site productivity, different concerns exist when managing different ecosites. Based on a recently-conducted expert opinion survey, the major concerns when harvesting black spruce from shallow-soil, upland sites were: 1) harvest-related nutrient removals, and 2) loss of organic matter. In contrast to these ecosites, the major concerns for organic sites (including wet, mineral soils) were: 1) altered hydrology, and 2) rutting. The water table on these sites is typically near the surface for a significant portion of the frost-free season, minimizing organic matter decomposition and associated nutrient release. Any forest management practice which exacerbates this situation would have a negative impact on site productivity. Tree nutrient cycling studies conducted on shallow-soil sites in northwestern Ontario were presented to show that calculated nutrient replacement times, with the exception of K, did not exceed current rotation periods. However, the forest floor nutrient pool represented a major component of the soil reserves. Based on the importance of this nutrient pool, best practices designed to protect and allow for the rebuilding of this active soil pool are essential if long-term site productivity is to be maintained.This paper outlines a series of steps to evaluate and correct management-induced changes in long-term site productivity. These steps included: 1) the development of "best practice" guidelines, 2) the development of a set of "criteria and indicators", and 3) the establishment of long-term experimental field trials. The results of this third step should, in turn, be used to refine the "best practice" guidelines and suggest alternative "criteria and indicators" that should be incorporated into a monitoring program of forest sustainability. Key words: forest health, ecosystem management, site productivity, nutrient cycling

Developing Occupational Therapy Best Practice Guidelines for Acute Medical Services

2008 ◽  
Vol 7 (2) ◽  
pp. 97-100
Author(s):  
Nicola Mearns ◽  
◽  
Alison Millar ◽  
Fiona Murray ◽  
Susanne Fraser ◽  
...  
Keyword(s):  
Occupational Therapy ◽  
Practice Guidelines ◽  
Best Practice ◽  
Good Practice ◽  
Occupational Therapists ◽  
Evidence Base ◽  
Flow Chart ◽  
Therapy Process ◽  
Acute Medicine ◽  
Best Practice Guidelines

Occupational Therapists began exploring their role in Acute Medicine in the late 1990’s.1 A decade later the presence of Occupational Therapists in accident & emergency departments and acute medical units is seen as routine. The literature and evidence base to support this, however, has not progressed as rapidly. With few guidelines to support practice the authors produced a document locally to promote standardisation of good practice and equity of treatment within all relevant NHS Lothian and NHS Borders sites. A table illustrates the specialist skills necessary for Occupational Therapy in Acute Medicine and appendices outline components of various assessments. It is hoped that as therapists progress through the flow chart they can utilise further sections of the guidelines related to specific assessments. This article will introduce the reader to the occupational therapy process in acute medicine and describe the guidelines that are currently in use.

A unit-level perspective on the long-term sustainability of a nursing best practice guidelines program: An embedded multiple case study

2016 ◽  
Vol 53 ◽  
pp. 204-218 ◽  
Author(s):  
Andrea R. Fleiszer ◽  
Sonia E. Semenic ◽  
Judith A. Ritchie ◽  
Marie-Claire Richer ◽  
Jean-Louis Denis
Keyword(s):  
Practice Guidelines ◽  
Best Practice ◽  
Multiple Case Study ◽  
Unit Level ◽  
Best Practice Guidelines ◽  
Multiple Case

scholarly journals An analysis of errors, discrepancies, and variation in opioid prescriptions for adult outpatients at a teaching hospital

2017 ◽  
Vol 13 (1) ◽  
pp. 51 ◽  
Author(s):  
Mark C. Bicket, MD ◽  
Deepa Kattail, MD ◽  
Myron Yaster, MD ◽  
Christopher L. Wu, MD ◽  
Peter Pronovost, MD, PhD
Keyword(s):  
Practice Guidelines ◽  
Interrater Reliability ◽  
Best Practice ◽  
Prescribing Patterns ◽  
Government Regulations ◽  
Opioid Medication ◽  
Drug Enforcement ◽  
Opioid Prescribing ◽  
Best Practice Guidelines ◽  
Drug Enforcement Agency

Objective: To determine opioid-prescribing patterns and rate of three types of errors, discrepancies, and variation from ideal practice.Design: Retrospective review of opioid prescriptions processed at an outpatient pharmacy.Setting: Tertiary institutional medical center.Patients: We examined 510 consecutive opioid medication prescriptions for adult patients processed at an institutional outpatient pharmacy in June 2016 for patient, provider, and prescription characteristics.Main Outcome Measure(s): We analyzed prescriptions for deviation from best practice guidelines, lack of two patient identifiers, and noncompliance with Drug Enforcement Agency (DEA) rules.Results: Mean patient age (standard deviation) was 47.5 years (17.4). The most commonly prescribed opioid was oxycodone (71 percent), usually not combined with acetaminophen. Practitioners prescribed tablet formulation to 92 percent of the sample, averaging 57 (47) pills. We identified at least one error on 42 percent of prescriptions. Among all prescriptions, 9 percent deviated from best practice guidelines, 21 percent failed to include two patient identifiers and 41 percent were noncompliant with DEA rules. Errors occurred in 89 percent of handwritten prescriptions, 0 percent of electronic health record (EHR) computer-generated prescriptions, and 12 percent of non-EHR computer-generated prescriptions. Interrater reliability by κ was 0.993.Conclusions: Inconsistencies in opioid prescribing remain common. Handwritten prescriptions continue to demonstrate higher associations of errors, discrepancies, and variation from ideal practice and government regulations. All computer-generated prescriptions adhered to best practice guidelines and contained two patient identifiers, and all EHR prescriptions were fully compliant with DEA rules.

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