CONTRAST BETWEEN PROTOCOL AND PRACTICE IN THE PRESCRIPTION OF OPIOIDS IN PAEDIATRIC INPATIENTS: AN AUDIT

C. Mellor, S. Rahman, Y. F. Rannan-Eliya, R. Hain. University Hospital of Wales, Cardiff, UK

Aim: To compare current practice with local guidelines for prescribing opioids in children based on the WHO pain ladder.

Background: An audit of severe pain management in 2005 demonstrated inadequate documentation of pain assessment and inaccuracies in opioid prescribing. Following dissemination of these findings we are re-auditing practice.

Methods: Patients that had received opioids were identified from ward-controlled drug record books. Using the same questionnaire as the 2005 audit, management of the episodes was audited against local guidelines.

Results: The audit is ongoing. So far, 27 patients who received strong opioids have been identified. 20 (74%) had acute pain, six of whom were managed by the acute pain team using patient controlled analgesia systems. Five (19%) were palliative care patients with pain and two (7%) received opioids for non-pain indications. We have identified four gaps in practice: failure to administer laxatives pre-emptively; prescribing incorrect doses of regular opioids; prescribing opioids for use on an as required basis only; and paucity of documentation of the assessment of pain.

Conclusions: There remain deviations from recommended practice in the management of severe pain in children at our tertiary paediatric inpatient unit. We plan to implement a teaching intervention and repeat this audit.

END OF LIFE PLANNING IN A REGIONAL CHILDREN’S HOSPICE SERVICE: REVIEW OF CURRENT PRACTICE AND A FRAMEWORK FOR IMPROVEMENT

N. Harris, B. Hughes. Children’s Hospice South West, Fremington, Devon, UK

Aim: Children accepted on to hospice caseloads are those where there is a reasonable expectation that the child may die before adulthood. These children may have long periods of stable health, but are at risk of rapid deterioration or sudden death, which, despite a diagnosis of a life-limiting condition, may overtake a family’s preparation for the death of their child. Our hospice undertook a review of all children’s notes, and consultation with their hospice key …