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Driving communication forward: improving communication for palliative care patients around driving and opioids – a quality improvement report

INTRODUCTION: The number of people requiring palliative care is increasing with an ageing comorbid population. Pain is a prevalent symptom for palliative care patients and is often managed with opioids. Opioids reduce reaction time and can cause drowsiness and visual disturbance. Evidence recommends...

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Autores principales: Ismail-Callaghan, Seline, Howarth, Megan, Allan, Rebecca, Davey, Nicola, Meddick-Dyson, Stephanie Amanda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9923252/
https://www.ncbi.nlm.nih.gov/pubmed/36754541
http://dx.doi.org/10.1136/bmjoq-2022-002138
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author Ismail-Callaghan, Seline
Howarth, Megan
Allan, Rebecca
Davey, Nicola
Meddick-Dyson, Stephanie Amanda
author_facet Ismail-Callaghan, Seline
Howarth, Megan
Allan, Rebecca
Davey, Nicola
Meddick-Dyson, Stephanie Amanda
author_sort Ismail-Callaghan, Seline
collection PubMed
description INTRODUCTION: The number of people requiring palliative care is increasing with an ageing comorbid population. Pain is a prevalent symptom for palliative care patients and is often managed with opioids. Opioids reduce reaction time and can cause drowsiness and visual disturbance. Evidence recommends that driving should be avoided until a stable dose of opioids has been reached. It is vital for patient and public safety that these facts are communicated to patients who are prescribed opioids, as well as the legal consequences if guidance is not followed. These discussions facilitate joint decisions, optimising patient freedom and quality of life. Surprisingly though these important discussions around driving and opioids do not always occur, and so this project sought to develop a systematic approach to integrating them into practice. DESIGN: Retrospective case note analysis and prospective interventional quality improvement study. SETTING: A 16 bedded specialist palliative care inpatient unit. POPULATION: Hospice inpatients with an Eastern Council Oncology Group performance score of 0–3 who had been prescribed opioids. INTERVENTION: Three plan–do–study–act cycles were performed. First, the issue was discussed in the daily multidisciplinary team meeting to raise awareness, second a prompt was added to a pre-existing clerking proforma. Finally, a reminder poster was placed in the ward office to promote discussion prior to discharge. OUTCOME MEASURES: Primary measures were the proportion of patients with the presence of documented driving status, and the presence of a documented discussion surrounding driving and opioids. RESULTS: Baseline data found that 11.5% of patients had a documented driving status and 11.5% had a documented discussion surrounding driving and opioids. Over the course of the study, the proportion improved to 65.2% and 60.9%, respectively. CONCLUSION: Use of quality improvement change methods have resulted in the successful integration of new interventions to increase discussions around driving when prescribed opioids. A previously overlooked issue in this facility, thus improving clinical and patient information sharing, and patient empowerment to take charge of their own health.
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spelling pubmed-99232522023-02-14 Driving communication forward: improving communication for palliative care patients around driving and opioids – a quality improvement report Ismail-Callaghan, Seline Howarth, Megan Allan, Rebecca Davey, Nicola Meddick-Dyson, Stephanie Amanda BMJ Open Qual Quality Improvement Report INTRODUCTION: The number of people requiring palliative care is increasing with an ageing comorbid population. Pain is a prevalent symptom for palliative care patients and is often managed with opioids. Opioids reduce reaction time and can cause drowsiness and visual disturbance. Evidence recommends that driving should be avoided until a stable dose of opioids has been reached. It is vital for patient and public safety that these facts are communicated to patients who are prescribed opioids, as well as the legal consequences if guidance is not followed. These discussions facilitate joint decisions, optimising patient freedom and quality of life. Surprisingly though these important discussions around driving and opioids do not always occur, and so this project sought to develop a systematic approach to integrating them into practice. DESIGN: Retrospective case note analysis and prospective interventional quality improvement study. SETTING: A 16 bedded specialist palliative care inpatient unit. POPULATION: Hospice inpatients with an Eastern Council Oncology Group performance score of 0–3 who had been prescribed opioids. INTERVENTION: Three plan–do–study–act cycles were performed. First, the issue was discussed in the daily multidisciplinary team meeting to raise awareness, second a prompt was added to a pre-existing clerking proforma. Finally, a reminder poster was placed in the ward office to promote discussion prior to discharge. OUTCOME MEASURES: Primary measures were the proportion of patients with the presence of documented driving status, and the presence of a documented discussion surrounding driving and opioids. RESULTS: Baseline data found that 11.5% of patients had a documented driving status and 11.5% had a documented discussion surrounding driving and opioids. Over the course of the study, the proportion improved to 65.2% and 60.9%, respectively. CONCLUSION: Use of quality improvement change methods have resulted in the successful integration of new interventions to increase discussions around driving when prescribed opioids. A previously overlooked issue in this facility, thus improving clinical and patient information sharing, and patient empowerment to take charge of their own health. BMJ Publishing Group 2023-02-08 /pmc/articles/PMC9923252/ /pubmed/36754541 http://dx.doi.org/10.1136/bmjoq-2022-002138 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Quality Improvement Report
Ismail-Callaghan, Seline
Howarth, Megan
Allan, Rebecca
Davey, Nicola
Meddick-Dyson, Stephanie Amanda
Driving communication forward: improving communication for palliative care patients around driving and opioids – a quality improvement report
title Driving communication forward: improving communication for palliative care patients around driving and opioids – a quality improvement report
title_full Driving communication forward: improving communication for palliative care patients around driving and opioids – a quality improvement report
title_fullStr Driving communication forward: improving communication for palliative care patients around driving and opioids – a quality improvement report
title_full_unstemmed Driving communication forward: improving communication for palliative care patients around driving and opioids – a quality improvement report
title_short Driving communication forward: improving communication for palliative care patients around driving and opioids – a quality improvement report
title_sort driving communication forward: improving communication for palliative care patients around driving and opioids – a quality improvement report
topic Quality Improvement Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9923252/
https://www.ncbi.nlm.nih.gov/pubmed/36754541
http://dx.doi.org/10.1136/bmjoq-2022-002138
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