Using visual prompts to aid analgesia prescribing.

Analgesia prescribing is fundamental to a patient's journey, affecting length of stay and patient experience. Laminated prompts are used throughout the NHS Foundation Trust to aid doctors prescribing. A baseline questionnaire was carried out to gather doctors' prescribing habits and current ability to convert opioids to their morphine equivalent. Ninety three percent of doctors said they were moderately to extremely confident when prescribing analgesia. However, when asked to carry out a simple opioid conversion only 14% answered correctly. Eighty three percent of doctors said they were prescribing laxatives alongside opioids frequently (57%) or almost all the time (25%). When actual rates were sampled only 14% of patients were prescribed a concurrent laxative. Laminated pain management guideline cards were created and distributed to doctors at sign in for weekly teaching. Doctor interviews were carried out to see if they were in possession of a prompt card and a simple opioid conversion question was asked. If they did not have a prompt card at the time of interview they were issued with one after answering the conversion question. Rates of concurrent laxative prescribing were collected from the electronic prescribing record of patients on the acute medical unit. Posters were displayed in doctors' offices and drug rooms. Laxative prescribing rates were re-collected and compared with the survey responses. Distribution of laminated prompts increased accuracy of opioid conversion by 86%. Error rates fell as prompt prevalence increased until there was 100% prevalence and 0% error. Concurrent prescribing of laxatives increased to 50% after posters were displayed around the acute medical unit. Doctors reported they were confident when prescribing analgesia. They reported that they often prescribed concurrent medications, however this did not relate to actual prescribing practices. Visual prompts improved doctors analgesia conversion knowledge and prescribing practices. Laminated prompt cards are now incorporated in new doctors' induction packs.