Aim To assess whether paediatric patients who were prescribed opioids, had also been prescribed naloxone.

Methods The audit was registered with the Clinical Audit and Effectiveness Department and ethical approval was not required. Patients who were taking weak opioids were excluded from this audit. A data collection sheet was created and data collected prospectively, over a two-month period. Forty-one inpatient medication charts were reviewed, to identify whether naloxone had been prescribed on the PRN section of the chart for patients who had been prescribed opioids, also to see whether the standards set for this audit had been met. The data was analysed with Microsoft excel.

Results There were 41 paediatric inpatient charts reviewed in total. Three standards were set for this audit which were derived from local ‘Multidisciplinary Guidelines for Acute Pain Management in Children and Young People’.¹ The first standard was that ‘all paediatric patients who are prescribed opioids should have naloxone prescribed’ which was met by 17% (7/41) of the inpatient charts. The second standard was that ‘naloxone should be prescribed on the ‘when required’ PRN section of the drug chart’ which was met by 100% (7/7) of the inpatient charts. The last standard was that ‘the directions for naloxone should include instructions to call a medical practitioner and to immediately commence the administration, if respiratory depression is encountered’,^{1 2} which was met by 86% (6/7) of the inpatient charts.

Conclusion There is significant lack of naloxone prescribing in paediatric patients who are on opioids. This is reflected from the results showing that only 17% (7/41) of patients on opioids had naloxone prescribed on the PRN section of the chart. The inpatient charts which had naloxone prescribed, did not all have the correct dose and instructions on how it should be administered, only 86% (6/7) did. The results suggest that there is a lack of understanding on the importance of naloxone and how it should be prescribed on inpatient charts. The findings of this audit will be presented at the Paediatric Audit meeting and the Surgical Paediatric meeting, to educate prescribers on the importance of prescribing naloxone in patients who are receiving opioids and to reduce adverse effects that could occur due to opioid toxicity.

References

1. Dunn G. Multidisciplinary Guidelines for Acute Pain management in children and young people, COIN, 2016, 55.

2. Committee JF. British National Formulary for Children, 2017–2018. London: BMJ Group and Pharmaceutical Press.