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Emanuel O, Mahdi S, Bondje S, Tjokarfa J, Dhunna J, Sivarajah V, Jose P. 695 Analgesic Ladder Compliance by Junior Doctors on Surgical Wards. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Analgesia makes up an integral part of the management of the surgical patient. The World Health Organisation “analgesic ladder” details the escalation of analgesics from paracetamol through to opiates. Over the past decade, opiate prescriptions in the UK have increased by 22% to 40.5 million a year.
Method
Drug charts were reviewed on the surgical wards prior to presentation of the trust guidelines to surgical juniors. Inclusion criteria was non-cancerous adults who were not on chronic pain medications and had no known allergy or contraindication to NSAIDs. F1/2s were also surveyed on their knowledge of the trust guidelines
Results
Compliance improved in weak opioids (10.6%) and oramorph (19.1%) but fell in NSAIDs (-2.9%). Paracetamol was prescribed appropriately in 100%. 78% of doctors admitted to not having read the trust guidelines and 89% to not following them despite 100% being aware of the concept of the analgesic ladder.
Conclusions
We saw a tangible improvement in opiate prescribing by surgical juniors. However, the overall compliance to the analgesic ladder is still relatively poor given the doctors are all aware of the concept of the analgesic ladder, suggesting appropriate analgesic prescribing does not rank as highly in importance as it should.
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Affiliation(s)
- O Emanuel
- East and North Herts NHS Trust, Hertfordshire, United Kingdom
| | - S Mahdi
- East and North Herts NHS Trust, Hertfordshire, United Kingdom
| | - S Bondje
- East and North Herts NHS Trust, Hertfordshire, United Kingdom
| | - J Tjokarfa
- East and North Herts NHS Trust, Hertfordshire, United Kingdom
| | - J Dhunna
- East and North Herts NHS Trust, Hertfordshire, United Kingdom
| | - V Sivarajah
- East and North Herts NHS Trust, Hertfordshire, United Kingdom
| | - P Jose
- East and North Herts NHS Trust, Hertfordshire, United Kingdom
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