Domain 2:

Safety and Quality: Audit

Example 2 - Prescribing for pain (5 or 8 criterion audit)

As an OOH doctor you will often see a high proportion of patients presenting for unscheduled care with specific needs such as pain control. Your prescribing will reflect this, but it is important to be able to demonstrate good practice in analgesic prescribing.

For one hundred serial consultations, note those in which you prescribe a certain class of drug and compare this against your chosen set of criteria and standards. You need to consider defining criteria and setting standards for topics such as:

  1. The proportion of your consultations that resulted in analgesic prescriptions
  2. Patients prescribed analgesics should have a condition or reason clearly recorded in their records
  3. Analgesics should be used which are in line with local formulary recommendations for first line use, unless clinically contraindicated
  4. If a non steroidal anti-inflammatory is used, gastric protection should be considered where appropriate (for example elderly, debilitated patients)
  5. Non steroidal anti-inflammatory drugs should generally be avoided in patients with a past history of GORD, ulcer disease or upper G-I haemorrhage
  6. Strong analgesics should be prescribed in small quantities on first presentation
  7. Patients with chronic pain should have a clear record and justification of any adjustment to their regime
  8. Patients who are prescribed opiates often experience constipation: for elderly patients a laxative should be co-prescribed or a warning of the risk given to the patient and recorded
  9. All analgesic prescribing should be accompanied by a check for known past history of hypersensitivity
  10. All analgesic prescribing should be accompanied by a check for potential drug interactions
  11. If a second line analgesic is used, the reason for its use should be documented

As an alternative, if your work requires you to provide and maintain a personal store of controlled drugs you could audit your personal arrangements for handling these:

  1. Your controlled drug register should contain details of all controlled drugs that you hold (Class A)
  2. Your injectable Class A drugs must be in a locked case or bag
  3. You have details of how to contact the appointed officer responsible for disposal of expired or redundant Class A drugs
  4. Your prescriptions for controlled drugs all meet the regulations (you will need to log these prescriptions or take copies prospectively for this criterion)
  5. No prescriptions for controlled drugs should exceed one month's supply

This page was last updated on: 18/08/2016