title: Prescription and administration of opioids to hospital in-patients, and barriers to effective use.
abstract: OBJECTIVE
  This study aimed to describe prescribing and administration of opioids in a tertiary referral teaching hospital. Secondary aims were assessment of staff knowledge of opioid pharmacology and available preparations, and of perceived barriers limiting opioid use.
  
  
  METHODS
  A cross-sectional survey of in-patients requiring opioid analgesia was performed. An anonymous semi-structured questionnaire was administered to medical and nursing staff.
  
  
  METHODS
  Australian tertiary referral teaching hospital.
  
  
  METHODS
  All patients prescribed opioids on study wards over 3 months (N = 190).
  
  
  RESULTS
  Oxycodone was the most frequently prescribed opioid (51.4%). The majority (64.7%) of participants had incomplete pain relief, which was significantly associated with having opioid related side effects. There was no association between pain relief and prescribed daily dose or received daily dose of opioids. Limited understanding of opioid preparations, tolerance, and dependence was demonstrated by staff. The most common perceived barriers to opioid use included difficulties in identifying the right dose, staff time required to prescribe and monitor, and large numbers of preparations. While prescription of inadequate doses was perceived as a barrier, this study identified that submaximal doses were administered. An opioid educational session improved knowledge of opioid formulations.
  
  
  CONCLUSIONS
  The majority of participants had incomplete pain relief and the maximum prescribed doses of opioids were not administered. Reported barriers included staff knowledge of opioid dose titration and opioid preparations, and time constraints. Identified barriers included poor knowledge of opioid preparations.
authors.affiliation: Drug Health Services, Royal Prince Alfred Hospital, Royal North Shore Hospital, Sydney, NSW, Australia. bmurnion@med.usyd.edu.au
authors.forename: Bridin P
authors.initials: BP
authors.lastname: Murnion
authors.forename: Danijela
authors.initials: D
authors.lastname: Gnjidic
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001315:Australia; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D004363:Drug Utilization; D005006:Ethnicity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009726:Nurses; D010098:Oxycodone / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D010820:Physicians; D014147:Tramadol / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol; D009020:Morphine; D010098:Oxycodone