Background & Aims

Increasing staff shortages, use of agency staff, patient acuity and increasing scope of nursing practice place greater demands on a nurse’s time than ever. As workload increases, the risk of adverse events also increases.
Additionally, the FPM recommends immediate release (IR) opioids in preference to modified release (MR) opioids to reduce opioid-related harm. The first line recommended opioid is oral morphine solution. Many hospitals, including our trust, continue to treat the solution as a schedule 2 CD.
During acute pain ward rounds we observed patients reporting long waits for as needed (PRN) opioids and delayed administration of MR opioids.
Better understanding of the process of control drug (CD) administration is required. The length of time taken to administer CDs may illustrate the demands that CD prescribing place on the nursing workload.
Our aims were to evaluate the nursing time spent administering CDs and consider the impact of CD prescribing trends on nursing time.

Methods

A ‘snapshot’ audit was taken on a single day at a 27-bedded trauma and orthopaedic ward at a The Royal London Hospital, a London Major Trauma Centre, to establish the number of episodes of analgesic CD administration over 24 hours.
Additionally, we spent time observing CD administration. Time was taken from the moment two nurses entered the clinical room with the CD keys, to the moment the patient received the drug. The researcher witnessed episodes where the correct policy for administration was not followed; these episodes were not included and were fedback to the ward team.
The data was used to model the time taken to administer opioids on an average day on this ward.

Results

During the study period, 22/27 (81%) patients had active prescriptions for strong opioids, ketamine or methadone. 65 episodes of CD administration occurred on the ward. 20 of these were for MR opioids.
10 episodes of CD administration were observed over three days to take a sample of timing. On average, nurses were observed to spend 368 seconds preparing and administering CDs.
This equates to 6.64 hours over 65 episodes in the course of 24 hours. Each episode requires two nurses hence CD administration accounts for 13.2 hours of nursing time. This equates to 91 hours per week, or 2.42 full time nurses (assuming a 37.5 hour working week).
MR opioid administration accounted for 2 hours of this time (20 episodes). Had these prescriptions been for IR strong opioids as per FPM guidance, this administration time would be doubled.

Conclusions

A significant number of nursing hours are spent on administration of CDs on a busy trauma and orthopaedic ward. This also has a large cost implication.
The time taken to sign out CDs could be a barrier to all patients on a ward receiving their drugs in a safe and timely fashion. It may also impact on prioritisation of other nursing tasks. It could be argued that effective analgesic prescribing should also consider the ability for staff to effectively administer the prescribed drugs. Although guidance states that IR opioids are preferable in post-operative pain, this increases administration time significantly.

References

1.Faculty of Pain Medicine (2021) Opioids Aware. Available at: https://www.fpm.ac.uk/opioids-aware (Accessed 31st January 2024)

Presenting Author

Harriet Scott

Poster Authors

Harriet Scott

MBBS BSc MRCP FRCA FFPMRCA

Barts Health

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Post-surgical/Post-traumatic Chronic Pain