Methadone prescribing in the general hospital

Abstract

Purpose – The purpose of this paper is to evaluate the clinical practice for management of opiate dependence in a general hospital in-patient population based on agreed standards and changes of clinical practice after the introduction of a guideline.

Design/methodology/approach – A complete cycle of audit was carried out based on the agreed guideline, which was introduced after the first cycle. Data were obtained, using a standardized audit form, over two one-year periods, by cross-sectional analysis of case notes for patients identified as having been dispensed methadone whilst an in-patient.

Findings – There were significant increases in: referral to the specialist service whilst an in-patient (p=0.01); referral to the addiction services on discharge (p<0.001) and providing information about the addiction diagnosis to GP (p<0.001). However, there was no improvement in the documented history and examination related to aspects of addiction, some of which were consistently low. Of most concern were significant decreases in the history documented for opiate withdrawal symptoms and alcohol consumption.

Research limitations/implications – The method used may not reflect actual clinical practice, only captures opiate-dependent patients prescribed methadone and does not establish the extent of awareness of the new guideline.

Practical implications – The paper identifies a variation in clinical practice of management of patients with opiate dependence in the general hospital. Though there were some significant improvements, further improvement and continual evaluation are needed.

Originality/value – The paper identifies the need to study how co-morbid opiate dependence is managed in the acute hospital setting.