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Used inappropriately these drugs have resulted in patient harm including death. It is important therefore that they are prescribed, dispensed and administered safely. This is especially true in mental health settings where use can be infrequent.
Out with medical emergencies (such as acute Myocardial Infarction/ Congestive Cardiac Failure) opioids should be prescribed as part of a clear treatment plan.
For pain management this should generally be part of a stepped approach as describe in the W.H.O pain ladder.
Advice on pain management can be obtained from local palliative care services.
Doses should start low and be increased incrementally until pain control is achieved. In substance misuse treatment should be part of a plan supported by Addiction Services.
All prescriptions must be written to the standards described in Instructions for the Use of the NHS GGC Mental Health Prescription sheet (MHS MRG 09) and NHS Greater Glasgow & Clyde Safe & Secure Handling of Medicines Policy.
Care should be taken to clearly distinguish between different formulations of the same drug e.g. Shortec (ordinary release oxycodone) & Oxypro (modified release oxycodone)
Staff administering opioids should have knowledge of the usual dose range and common side effects of these drugs. The current BNF will provide basic information and further information may be obtained from pharmacy as necessary.
Only administer medicines from a prescription sheet that complies with the standards described in the Instructions for the Use of the NHS GGC Mental Health Prescription sheet (MHS MRG 09).
Where possible administration of opioids should be undertaken by two members of staff. This allows for all aspects of the process to be cross-checked.
There are frequent incident reports involving controlled drug patches e.g. fentanyl. Most often the reports detail incidents where patches are no longer in situ when the time comes to change them. It is recommended that services adopt a standard process of checking that patches are in situ at every shift change.
Most of the drugs are controlled drugs and are subject to the storage and record keeping requirements of the relevant national legislation (for advice on this contact pharmacy).
Use of these drugs in a mental health setting is infrequent. Consequently, it is expected that most mental health wards would not routinely keeps these as stock items.
A limited number of wards may keep a small stock for urgent access out of hours.
Overdose with opioids can lead to fatal respiratory depression.
Other signs include drowsiness and slurred speech.
Where patients are newly prescribed opioids or are on high doses it would be prudent to consider monitoring respiratory function e.g. number, depth and O2 saturation.
There is guidance in GGC Medicines Adult Therapeutics Handbook on the reversal of opioid induced respiratory depression).
Last reviewed: 26 May 2020
Next review: 01 May 2023
Author(s): Safer use of medicines (mental health) group
Approved By: PMG-MH
Reviewer Name(s): Andrew Walker, Suzanne Burke