title: Breakthrough strong opioid analgesia prescription in patients using transdermal fentanyl admitted to a hospice.
abstract: Durogesic (fentanyl) patches have revolutionized pain relief, but patients still require breakthrough medication. A retrospective analysis of in-patient admission notes at a 25-bed hospice over a six-month period was carried out. Details of analgesia being used on admission for both background and breakthrough pain were obtained, and the appropriateness of the breakthrough dose for those patients using transdermal fentanyl was determined. During the study period 278 patients were admitted to the hospice and 56 (20 percent) were using transdermal fentanyl. Of these, 35 (62 percent) were prescribed strong opioid analgesia--the dose of breakthrough medication prescribed was appropriate in 11 patients (31 percent). Rescue dosing was less than recommended, in relation to prescribed transdermal fentanyl strength in 21 patients (60 percent) and greater than recommended in one patient (3 percent). In this study, short-acting strong opioid analgesia was not always prescribed for patients using transdermal fentanyl, and when they were prescribed, this was in the appropriate dose range in less than a third of patients.
authors.affiliation: Leicestershire Hospice, Leicester, England.
authors.forename: Iain
authors.initials: I
authors.lastname: Lawrie
authors.forename: Mari
authors.initials: M
authors.lastname: Lloyd-Williams
authors.forename: Esther
authors.initials: E
authors.lastname: Waterhouse
mesh_terms: D000279:Administration, Cutaneous; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005283:Fentanyl / Q000008:administration & dosage*; D017051:Hospice Care; D006801:Humans; D009020:Morphine / Q000008:administration & dosage*; D009369:Neoplasms / Q000188:drug therapy; D010148:Intractable Pain / Q000188:drug therapy*; D010166:Palliative Care; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl