Audit of morphine administration by East Midlands Ambulance Service (EMAS)
Winter, S. Jootun, R.
Winter, S.
Jootun, R.
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Abstract
Aim For pre-hospital administration of morphine, JRCALC
guidelines recommend recorded pain scores (PS) out of ten
before and after use, an anti-emetic adjunct and ENTONOX
provision prior to analgesic effect. This audit aimed to gain
insight into how rigorously these guidelines were being
adhered to in practice
Methods This clinical audit examined patients who had been
administered morphine by EMAS staff. Inclusion criteria were
patients who had received documented oral, intravenous or
intramuscular morphine within a three-month period. Those
who declined morphine were excluded. Data extracted from
the patient report forms included: patient demographics; documented PSs; morphine doses and routes; adjunct analgesics
and use of anti-emetics. This information was used to determine how appropriately PSs, analgesic adjuncts and antiemetics were being used alongside morphine.
Results There were 293 patients included in the audit. 205
(70.0%) had a PS documented before and after morphine
administration; 50 (17.1%) had one documented PS and 38
(13.0%) had none. 58 (19.8%) patients received ENTONOX
before the administration of morphine and 17 (5.8%) received
it after morphine. 218 (74.4%) had no record of ENTONOX
administration and only 100 (34.1%) patients were prescribed
an anti-emetic with morphine.
Conclusion There is potential for improved adherence to
JRCALC guidelines through increased awareness and education. We will trial this at EMAS through staff notices followed
by a re-audit in 4–6 months. Ideally, audits within other
ambulance services with more patients would be undertaken
for widespread quality improvement.
https://bmjopen.bmj.com/content/bmjopen/7/Suppl_3/A3.3.full.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/bmjopen-2017-EMSabstracts.9