Driving communication forward

Improving communication with palliative care patients about driving whilst taking opioids

Seline Ismail-Sutton, Rebecca Allan, Megan Howarth, University hospitals Dorset

Introduction

The number of people requiring end of life care is set to rise over the next 15 years [1], one of the most common symptoms experienced is pain. Opioid analgesics are often used to manage this. Opioids have a negative impact on psychomotor skills and cognitive processing, therefore having significant implications for patients who drive whilst taking them. However, discussing this with patients is often overlooked. It is vital for patient and public safety that patients understand guidance for driving whilst taking opioids, and the legal consequences of not following this. Further, in a time where quality of life is vital, the opportunity to optimise it should be grasped.

Aim

Increase frequency of documented evidence on recorded driving status and discussion on opioid driving guidance from baseline rate of 11.5% to 50% at the Macmillan Unit.

This should be achieved in the five month period between August 2021 and January 2022.

Cycle 1

Add prompt to clerking proforma to record driving status.

Current PDSA cycles

Raise awareness of issue with MDT.

Cycle

Add reminder poster in ward office to discuss this as part of discharge routine.

2

New prompt to act as a continuous reminder for driving status to be recorded.

Measurement definition

Chosen measure: documented driving status and discussion on guidance for driving whilst taking opioids.

Inclusions: All patients at Macmillan Hospice, Christchurch, with and ECOG 0-3 taking opioids.

Exclusions: Patients admitted with acute deterioration who did not improve, patients with an ECOG 4.

Data collection: Retrospective review of notes every month.

Diagnostics

Frequency of documented evidence remained low.

Discuss issue in morning MDT meeting.

Cycle 3

Increase discussions via prompt on consultant ward round sheet.

Improved discussion rate, not all team members engaging.

Future PDSA cycles

Cycle 4

New prompt on consultant ward round sheet to trigger discussion.

Cycle 5

Improve team engagement via a more formal method.

Some improvement, some boxes unfilled, did not always lead to discussion.

Add box to clerking proforma to record driving status.

Review notes, assess if positive impact achieved, feedback from colleagues.

Add section to ward round proforma for prompt and documentation.

Review effect of each intervention, assess which to keep or remove.

Results

Encourage this discussion to form part of discharge routine.

Reminder poster to discuss upon discharge and use existing guidance leaflets.

Reflections

Driving status box still frequently unfilled, possibly due to lack of team engagement.

Informal team discussion had little impact, more formal team discussions may be more effective.

Recording driving status did not always prompt driving rules discussion. Therefore, trigger may be better on consultant ward round sheet when more time available.

If so, it will be important to reassess and remove prompts on the clerking sheet to avoid unnecessary work effort.

Going forward, it will be useful to c onsider if these findings can be applied to community palliative care teams, and if driving guidance discussions are more suited to this setting.

Presentation and circulate email raising awareness of ongoing QI project.

Baseline rate for documented driving status and driving guidance discussions was 11.5%.

The first intervention had the least improvement of 3.9% in both.

The second yielded the greatest improvement in documented driving status and driving rules discussion.

At the end of the third PDSA cycle, driving status and driving guidance discussions were documented in 65.2% and 60.9% of cases, exceeding our SMART aim.