AB166. SOH23ABS_109. Audit of post-operative opioid prescribing in an Irish university teaching hospital

Background: Opioids are effective in treating moderate-severe pain. However, their use is limited by risk of side effects. Although slow-release opioids have previously been prescribed routinely after surgery, their association with dependence is now well recognised. In this context, national guidance on opioid prescribing in acute post-operative pain was published in 2022.

Methods: A prospective audit was carried out in a large university teaching hospital over seven consecutive days in November 2022. The population of interest was adult in-patients three days post- surgery. Patients were eligible for inclusion if there was ≥1 active opioid prescriptions on their drug chart. Data on patients’ demographics, anaesthetic and surgical factors, opioid drug choice and use of multi-modal analgesia were collected. Opioid prescriptions were audited against national guidance for opioid prescribing.

Results: A total of 51 patients and 62 opioid prescriptions were included. Some 54.7% (n=28) of patients were female and mean age was 60.7 years. Patients most commonly underwent general anaesthetic (n=38) and open surgery (n=45). Slow-release opioids accounted for 6.3% (3/48) of all opioid prescriptions initiated post-operatively. Immediate-release oxycodone was the most prescribed opioid overall (38/62). The intended duration, or need to review after four days, was not documented on any opioid prescription. All patients were concomitantly prescribed at least one other analgesic agent.

Conclusions: In this prospective audit, the limited use of slow-release opioids post-operatively aligned closely with national guidance. However, documentation of intended duration of opioid prescriptions was poor, and should be a focus for change in future audit cycles.

Keywords: Analgesia; opioid; pain; stewardship; surgery