SP 6.04 Changing Minds, Changing Practice: Improving Opioid Prescribing in General Surgery
Joshua Cooper, Kamila Rakhimova, Ayoola Olaleye, Soumendu GhoshAbstract
Background
Safe opioid prescribing remains a critical patient safety imperative; however, significant variations in clinical practices continue to exist, notwithstanding established national and local guidelines. This project aimed to evaluate prescribing behaviours, pinpoint deficiencies in both knowledge and adherence to protocols, and assess the efficacy of targeted interventions on improving compliance and outcomes.
Methods
A two-cycle audit was undertaken. A ten-item questionnaire assessed junior doctors’ knowledge, confidence, and attitudes towards safe opioid prescribing Trust guidelines CG1080 (2023). A retrospective review of fifty patient records (September–November 2025) measured compliance with six standards: use of the WHO analgesic ladder, initial pain assessment, preference for immediate-release opioids, naloxone prescribing, multimodal analgesia, and co-prescription of laxatives. Interventions included a concise prescribing aid, focused departmental teaching, and proposed electronic health record prompts. A re-audit in January 2026 evaluated changes.
Results
Baseline findings demonstrated inconsistent knowledge and wide variation in practice. Compliance rates were WHO ladder (71%), multimodal analgesia (77%), immediate-release opioids (77%), naloxone (30%), laxatives (29%), and pain assessment documentation (7%). Following interventions, improvements were observed in WHO ladder use (88%), multimodal analgesia (82%), and naloxone prescribing (32%). Pain assessment documentation improved to 20%, while laxative co-prescribing remained low (28%).
Conclusions
Targeted education and practical tools improved adherence to key standards. Persistent gaps, particularly in pain assessment and laxative prescribing, highlight the need for integrated electronic prompts and continued reinforcement. This approach offers a scalable model for enhancing opioid stewardship and reducing avoidable harm within surgical services