Title : Evaluating discharge opioid prescribing practices in elective surgical patients: A retrospective audit from a specialist rehabilitation and surgical service centre
Abstract:
Purpose of Study: While opioids remain essential for acute postoperative pain management, inappropriate prescribing—especially at hospital discharge—contributes significantly to ongoing opioid use, dependency, and diversion. National guidelines such as the Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard emphasise minimal effective dosing, short durations, multimodal strategies, and deprescribing plans. This audit investigates current opioid prescribing patterns at discharge for elective surgical patients and evaluates adherence to bet practice principles.Methods: A retrospective audit was conducted on all adult patients admitted to STARS surgical wards 6B and 6C following elective surgery between October 1, 2024, and January 1, 2025, with at least one overnight stay. Patients already on opioids pre-operatively or discharged directly from PACU were excluded. Data extracted from iEMR included demographics, procedure type, opioid and simple analgesia use during admission, discharge opioid prescription details (including type, quantity, duration, indication) and discharge simple analgesia details. Simple descriptive statistics were used to summarise findings.
Results: 580 patients met inclusion criteria. Orthopaedics accounted for the highest proportion of opioid discharges. Oxycodone was the predominant opioid prescribed both during admission and at discharge. A substantial number of discharge prescriptions aligned with manufacturer box sizes (e.g., 5 or 10 tablets), with limited tailoring to patient-specific needs. Only a minority of patients were documented as receiving counselling on opioid use or weaning strategies. Use of simple analgesia was universal during admission but underrepresented at discharge. Multimodal analgesia uptake and alignment with national guidelines were variable.
Conclusions: This audit highlights significant variation in discharge opioid prescribing practices and limited documentation of deprescribing or education strategies. The findings suggest a need for enhanced opioid stewardship at discharge, including personalised analgesic plans, improved documentation, and better implementation of national standards. Future efforts should focus on multidisciplinary interventions to support safer, more consistent prescribing practices
References: Australian Commission on Safety and Quality in Health Care (ACSQHC). (2022). Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard; NPS MedicineWise. (2021). Opioids: Reducing Harms and Managing Risks
