Effect of IPMOE on prescription pattern in Palliative Care Unit, Tuen Mun Hospital

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Abstract Summary

Effect of IPMOE on prescription pattern in Palliative Care Unit, Tuen Mun Hospital

Tin WY(1), Lo SH(1), Chan PC(1), Tong KO(1), Wong MC(1), Tung Y(1), Wong CS(1)

(1) Department of Clinical Oncology, Tuen Mun Hospital.

INTRODUCTION

Pain control audit is regularly performed in our palliative care unit to ensure service quality. Since the implementation of In-Patient Medication Order Entry (IPMOE) in January 2018, standardized drug sets were introduced for prescribing opioid analgesics and associated supportive medications. The latest audit was performed in Apr 2018 to delineate the effect of IPMOE on compliance with analgesic prescription in accordance with departmental protocol.

AIM

To review the analgesic and co-analgesic prescription pattern in pre-IPMOE and post-IPMOE setting.

METHODOLOGY

All patients with histological or radiological evidence of malignancy being newly transferred or admitted to palliative care ward in 2 weeks of April 2018, with at least 1 complete day of prescription of regular Tramadol or higher levels of analgesics were included. Patients’ demographic data and disease status were evaluated by a clinical oncologist. Data were compared with previous audit results in 2016. All medication records were reviewed using paper administration record in 2016 cohort, and IPMOE in 2018 cohort.

RESULT

One hundred and thirty-three patient-days were assessed in the audit. Compared with previous audit, there was an improvement in compliance in prescribing regular opioid analgesic l, rescue analgesic and supportive medications. The compliance to opioid prescription protocol increased from 46.8% patient-days in 2016 to 88% in 2018, with appropriate rescue analgesic prescribed in 95.3% patient-days in 2018, compared with 90.8% in 2016. Regular or as needed laxatives were prescribed in 95.5% patient-days in 2018, compared with 72.7% in 2016. However, mean number of co-analgesics also increased from 0.72 (range 0-3) in audit in 2016, to 1.62 (range 0-3). The most commonly prescribed analgesic was Paracetamol (66.9% in 2018 vs 16.7 % in 2016), followed by Dexamethasone (28.6% in 2018 vs 0% in 2016) and gabapentinoid (42.1% in 2018 vs 31.2% in 2016).

CONCLUSION

IPMOE enables the standardized use of drug sets for opioid and supportive medications prescription, and thus ensuring the quality and safety in patient management. The compliance to opioid prescription increased from 46.8% in 2016 to 88% in 2018. However, the increase in number of co-analgesics prescribed could be related to the use of IPMOE. It is suggested that IPMOE could be enhanced to reduce polypharmacy, prolonged course of treatment, and potential side effects.

Abstract ID :
HAC77
Submission Type
HA Staff
Authors (including presenting author) :
Tin WWY(1), Lo SH(1), Chan PC(1), Tong KO(1), Wong MC(1), Tung Y(1), Wong CS(1)
Affiliation :
(1) Department of Clinical Oncology, Tuen Mun Hospital.
Introduction :
Pain control audit is regularly performed in our palliative care unit to ensure service quality. Since the implementation of In-Patient Medication Order Entry (IPMOE) in January 2018, standardized drug sets were introduced for prescribing opioid analgesics and associated supportive medications. The latest audit was performed in April 2018 to delineate the effect of IPMOE on compliance with analgesic prescription in accordance with departmental protocol.
Objectives :
To review the analgesic and co-analgesic prescription pattern in pre-IPMOE and post-IPMOE setting.
Methodology :
All patients with histological or radiological evidence of malignancy being newly transferred or admitted to palliative care ward in 2 weeks of April 2018, with at least 1 complete day of prescription of regular Tramadol or higher levels of analgesics were included. Patients’ demographic data and disease status were evaluated by a clinical oncologist. Data were compared with previous audit results in 2016. All medication records were reviewed using paper administration record in 2016 cohort, and IPMOE in 2018 cohort.
Result & Outcome :
RESULT One hundred and thirty-three patient-days were assessed in the audit. Compared with previous audit, there was an improvement in compliance in prescribing regular opioid analgesic, rescue analgesic and supportive medications. The compliance to opioid prescription protocol increased from 46.8% patient-days in 2016 to 88% in 2018, with appropriate rescue analgesic prescribed in 95.3% patient-days in 2018, compared with 90.8% in 2016. Regular or as needed laxatives were prescribed in 95.5% patient-days in 2018, compared with 72.7% in 2016. However, mean number of co-analgesics also increased from 0.72 (range 0-3) in audit in 2016, to 1.62 (range 0-3). The most commonly prescribed analgesic was Paracetamol (66.9% in 2018 vs 16.7 % in 2016), followed by Dexamethasone (28.6% in 2018 vs 0% in 2016) and gabapentinoid (42.1% in 2018 vs 31.2% in 2016). CONCLUSION IPMOE enables the standardized use of drug sets for opioid and supportive medications prescription, and thus ensuring the quality and safety in patient management. The compliance to opioid prescription increased from 46.8% in 2016 to 88% in 2018. However, the increase in number of co-analgesics prescribed could be related to the use of IPMOE. It is suggested that IPMOE could be enhanced to reduce polypharmacy, prolonged course of treatment, and potential side effects.
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