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...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-02-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/12/1/e002138.full |
| _version_ | 1797905435333754880 |
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| author | Nicola Davey Rebecca Allan Seline Ismail-Callaghan Megan Howarth Stephanie Amanda Meddick-Dyson |
| author_facet | Nicola Davey Rebecca Allan Seline Ismail-Callaghan Megan Howarth Stephanie Amanda Meddick-Dyson |
| author_sort | Nicola Davey |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-10T10:05:14Z |
| format | Article |
| id | doaj.art-0658b7de70ec485990785dca97e2497b |
| institution | Directory Open Access Journal |
| issn | 2399-6641 |
| language | English |
| last_indexed | 2024-04-10T10:05:14Z |
| publishDate | 2023-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj.art-0658b7de70ec485990785dca97e2497b2023-02-15T23:30:10ZengBMJ Publishing GroupBMJ Open Quality2399-66412023-02-0112110.1136/bmjoq-2022-002138Driving communication forward: improving communication for palliative care patients around driving and opioids – a quality improvement reportNicola Davey0Rebecca Allan1Seline Ismail-Callaghan2Megan Howarth3Stephanie Amanda Meddick-Dyson4Quality Improvement Coaching, Quality Improvement Clinic Ltd, Shedfield, UKUniversity Hospitals Dorset NHS Foundation Trust, Poole, UKUniversity Hospitals Dorset NHS Foundation Trust, Poole, UKUniversity Hospitals Dorset NHS Foundation Trust, Poole, UKLeeds Teaching Hospitals NHS Trust, Leeds, UKIntroduction 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.https://bmjopenquality.bmj.com/content/12/1/e002138.full |
| spellingShingle | Nicola Davey Rebecca Allan Seline Ismail-Callaghan Megan Howarth Stephanie Amanda Meddick-Dyson Driving communication forward: improving communication for palliative care patients around driving and opioids – a quality improvement report BMJ Open Quality |
| 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 |
| url | https://bmjopenquality.bmj.com/content/12/1/e002138.full |
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