Oral Morphine Prescription Pattern accuracy: Are we doing it right?

Abstract

Objectives: Oral morphine is a potent, cheap, easy to use analgesia for moderate to severe pain. The aim of this study is to review the pattern of oral morphine prescription amongst different cadres of Doctors in OOUTH, a Nigerian tertiary hospital. The objectives were to determine how accurately oral morphine prescriptions were written and to find out if the wrong prescriptions were also dispensed.

Methods: All prescriptions on oral morphine were retrieved from the hospital's pharmacy records for the period between 1^st August 2016 (when oral morphine was introduced to the facility) and 28^th February 2018. The data captured included details of the prescriber, the strength and dosage of oral morphine, how accurate each prescription was, and strength of oral morphine often prescribed, and the data was analyzed manually.

Results: One hundred and forty-two (142) prescriptions were retrieved. The prescribers included; Resident Doctors (Junior and Senior Residents), Consultants and House/Officers/Medical Officers in 72 (50%), 58 (40.2%) and 14 (9.7%) respectively. The specialties of the doctors that prescribed oral morphine included: General Surgery (62%), Palliative Care (21.8%), Paediatric Surgery (0.7%), while Gynaecology, Internal Medicine, Haematology, Orthopedics and Otolaryngology had 1.4% each with two (2) prescriptions each (1.4%), The remaining 4.9% of the prescriptions were from medical officers at the Accident & Emergency Unit. The strength of oral morphine prescribed was distributed as follows: 10mg/5mls (42.2%), 5mg/5ml (40.8%), 2.5mg/5mls (10.6%), 20mg/5mls (3.5%) and 7.5mg/5mls (2.8%). There were 25 (17.6%) wrong prescriptions and these were written mostly by medical officers and house officers. The errors in prescriptions were mainly in terms of writing volume with no strength indicated and dose prescribed with ambiguous timing intervals.

Conclusion: Oral morphine is widely prescribed in this tertiary facility in a developing country and close to one-fifth of the prescriptions was wrong. Therefore, there is a need for training and re-training of prescribers and dispensers for optimal patient safety.