TPT 6.06 A Comprehensive Audit of Safe Opioid Prescribing Across Surgical Departments at Queen Elizabeth Hospital, Birmingham (QEHB)
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ID: 324049
2026
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Abstract
Abstract Aim Opioids are the mainstay of pain management on surgical wards being highly effective analgesics, however, have common significant side effects of nausea, vomiting and constipation due to slowed gut motility. Respiratory depression remains a dangerous adverse effect. The University Hospitals Birmingham (UHB) safe opioid prescribing guidelines recommend co-prescription of laxatives, anti-emetics, and naloxone to mitigate these risks. This audit aimed to assess and improve guideline adherence across a range of surgical departments at QEHB. Method Data analysis included all surgical inpatient parameters: demographics, diagnoses, opioid and concurrent prescriptions. Targeted interventions implemented: clinical staff education, educational posters, weekly team reminders. Prescribing practices were reviewed across multiple cycles to evaluate impact. Results This audit within 9 surgical departments (n=533) at QEHB found 80-90% of inpatients on strong opioids, but concurrent prescribing rates in cycle 1 were below 50% in several departments. On further analysis, antiemetic co-prescribing consistently improved, exceeding 75% across all cycles in all 9 departments. Laxative and naloxone prescribing rates, initially variable within Upper GI/Sarcoma, Urology, Colorectal, General Surgery, Trauma and Orthopaedics, Burns, Hands and Plastics, showed progressive improvement with several achieving rates > 70%. However, co-prescribing laxatives remained suboptimal in Colorectal (33%) and General Surgery (40%). Conclusion This comprehensive closed-loop audit with targeted interventions significantly improved adherence to UHB recommendations. Covering 9 surgical departments and >500 patients, it highlighted a large gap in safe opioid prescribing practices, needing reinforcement. A simple methodology allowed vast expansion across departments with straightforward impact on patient safety: preventable post-operative GI symptoms, improved rehabilitation, reduced inpatient stay.
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| Authors | Queenstone Baker, Kaviya Selvapandian, Komal Bodkhe, Avanti Banerjee, Akshara Sharma, Elif Demirtas |
| Journal | the british journal of surgery |
| Year | 2026 |
| DOI |
10.1093/bjs/znag087.229
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| URL | |
| Keywords | Keywords not found |
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