Christian Perkins
Introduction
The use of short-acting opioids such as fentanyl to facilitate same-day discharge is supported by organisations including the British Association of Day Surgery and Getting it Right First Time. Compared with morphine, fentanyl is associated with fewer side effects that may delay discharge, including post-operative nausea and vomiting (PONV) and post-operative urinary retention (POUR). A paper prescribing system currently exists for post-operative analgesia in recovery, with pre-printed morphine stickers readily available. In contrast, fentanyl prescriptions require full handwritten instructions. We evaluated whether introducing
standardised fentanyl prescription stickers could remove this barrier and increase its use in recovery.
Methods
A retrospective snapshot review of one week of elective surgeries was undertaken to assess post-operative fentanyl prescribing compared with morphine. Paediatric, orthopaedic, sedation and ophthalmic cases were excluded due to different post-operative pathways. Standardised pre-printed fentanyl prescription
stickers were introduced, followed by a repeat snapshot review two weeks later.
Results
There were 134 cases in the first cycle and 63 in the second. Morphine prescribing decreased from 73.1% to 39.7%, while fentanyl prescribing increased from 23.1% to 58.7%. PONV episodes reduced from 9 to 1, and POUR from 2 to 0.
Conclusions
By removing a prescribing barrier, we enabled colleagues to consider and use fentanyl in recovery more which has led to a reduction in complications which may delay or prevent same day discharge. Simple, practical and low-cost solutions can bring about impactful changes which promote successful day surgery.
Authors
Christian Perkins, Mui Liu
Luton & Dunstable Hospital, Luton, United Kingdom