Improving Antiemetic and Analgesic Prescribing Practices for Patients With Advanced Liver Disease: A Clinical Audit

TL;DR

This study shows that targeted education and local guidelines can improve pain and nausea medication prescriptions for patients with advanced liver disease.

Contribution

The study demonstrates that educational interventions and local guidelines can reduce inappropriate prescribing practices in patients with cirrhosis.

Findings

Prescription of weak opioids decreased from 23% to 11% after interventions.

Inappropriate antiemetic prescriptions dropped from 45% to 17%.

Significant variability remained in prescribing laxatives, adjuvants, and topical analgesics.

Abstract

Background and objective

Previous studies have demonstrated that local analgesic and antiemetic prescribing practices were inconsistent with best practices. In light of this, we aimed to assess the current prescribing practices against best practices, as defined by national guidelines.

Methods

This study involved a point-prevalence audit in the inpatient gastroenterology wards at a University Teaching Hospital in Glasgow. Patients were identified by case notes; a clinical diagnosis of cirrhosis documented by a consultant hepatologist was required for inclusion. Data including Child-Pugh score and prescribed medications were collected. Prescribing practice was reaudited after each
intervention. Interventions included educational seminars, posters, and the formulation of new local guidelines.

Results

A total of 249 inpatients were included; 70 were identified as having a clinical diagnosis of cirrhosis. The number of patients who were prescribed weak opioids decreased from 23% in cycle 1 to 11% in cycle 3. Prescription of 3 g/day paracetamol decreased from 36% to 24%. The number of patients who were prescribed an inappropriate antiemetic decreased from 45% to 17%. Laxatives, topical analgesics, and adjuvant analgesics were variably prescribed in all three cycles.

Conclusions

The development of concise local guidelines and targeted educational interventions for junior medical staff can improve prescribing practices for inpatients with decompensated cirrhosis. Currently, significant variability exists in the routine prescription of laxatives, adjuvants, and topical analgesics.

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