An audit of morphine prescribing in a specialist cancer hospital

The object of this study was to assess the quantity and quality of morphine prescribing in a specialist cancer hospital. An audit of prescription charts of all patients was performed using palliative care unit recommendations as the standard. The major weaknesses identified in morphine prescription were a lack of provision of breakthrough doses, the use of 'as required' (prn) oral morphine in the absence of regular oral morphine, and the lack of reference in the unit guidelines to co-prescription of aperients, antiemetics and night sedation. These deficiencies were targeted in an education programme and the survey was repeated to complete the audit cycle. Although some improvement in prescribing practice was shown, persistent problems have illustrated the need for an ongoing hospital-wide education programme.