Victoria Hewitt's design narrative
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2 April 2015
Educating GPs about safer opioid prescribing at the end of life
Narrator: I am a senior palliative care physician, with a special interest in safe medicines management at the end of life. I'm also a lecturer at the Graduate Medical School, leading a pain management course. Hence, when an educational programme to address some issues of unsafe prescribing practice amongst local GPs was proposed, I was approached to design and lead it.
Situation: The community palliative care team had identified and reported a number of prescribing errors amongst their patients. Analysis of these incidents showed that the safe prescribing of strong opioids (such as morphine and oxycodone) for pain control in people in the last few weeks of life was an issue, particularly in kidney failure. Some strong opioids were more risky than others, particularly those that were injected. There was no pattern of prescriber, practice or location. Strong opioids are known to "high risk" drugs and this is monitored nationally (Medicines Safety Thermometer). The local Clinical Commissioning Group (CCG) agreed that education was required.
Task: To educate GPs about safer opioid prescribing at end of life, making them aware of pitfalls and enabling them to implement procedures to mitigate these risks. Success was measured by participant feedback from the educational events and from the number of opioid-related drug errors identified.
Results: The sessions evaluated well, with a total of 40 attendees. Everyone made a pledge and consented to it being shared. A minority of participants did not like the group work, stating a preference for didactic "talk and chalk" learning. It's too early to know whether drug errors have reduced and we may never be able to measure exactly how much these sessions have contributed to safer patient care. However, the CCG has formally commissioned more education, so I interpret that as success. Unexpected learning came in relation to our system for booking classrooms
Reflections: These sessions had the potential to be confrontational, as we (te hospice team) had identified an area of inadequate practice in the professional group we were educating. I had to ensure there wouldn't be an "us and them" hierarchy. I tried to do this by making it a collaborative effort and it largely worked. We will have to see if it has contributed to safer care by monitoring error reports. I would definitely try this approach again rather than the usual large group teaching. I was also pleased that everyone made a pledge, even if it was from a sense of bemusement rather than genuine commitment.