Background: Recent judicial decisions involving informed consent have led to some medical practitioners altering the way they obtain consent. The aim of this study was to determine the degree to which patients understood the risks associated with a surgical procedure after giving routine consent and whether providing additional detailed verbal and/or written information improved their understanding. It was further determined whether the provision of more extensive information Altered patients' anxiety levels. Methods: Patients undergoing femoral popliteal bypass or carotid surgery were randomized to obtain either routine consent only or routine consent with verbal or written or verbal and written consent. Patients undertook a pre-operative risk and complication questionnaire, a pre-and postoperative anxiety and depression evaluation and a follow-up questionnaire 6 weeks after discharge. Results: Thirty-two patients were included in the trial. The comprehension questionnaire resulted in a correct percentage response of 48% for the routine information only, 59% with added verbal information, 59% with added written information and 55% with added written and verbal information. Twenty-five per cent of patients stated that they had a poor understanding of the risks and complications of the procedure. Conclusions: Additional written or verbal information did not improve a patient's understanding of risks and complications of the procedure. It also did not improve patients' perceived understanding of the operation or its complications. Patients' anxiety levels were unaltered by the increase in the information they were given. The information provided to patients should be simple, easy to understand and list any possible major complications to enable the patient to determine whether to undergo or decline a procedure.

Background: This study aimed to investigate the effects of an intervention focusing on better opioid prescription practice in a tertiary metropolitan hospital orthopaedic unit. Methods: Following a previous audit of opioid prescribing in the orthopaedics unit, an intervention comprising the (i) Expert Advisory Group oversight of opioid prescribing, (ii) development of a prescription opioid guideline for various hospital contexts and (iii) a series of education sessions was undertaken to improve opioid prescription practice. A reaudit was subsequently carried out to determine whether the intervention had had an impact on the previously audited orthopaedic unit. Results: Each audit period was 6 months. There were 281 orthopaedic patients in the original audit (). In both audits, a high proportion of patients were discharged to the community on opioids, 82.2% (n = 231) pre-intervention and 79.6% (n = 230) post-intervention. Statistically significant differences in opioid prescribing were found between audits, including: a reduction in the number of patients discharged on combination opioids from 71.4% to 45.7% (P < 0.001), a reduction in the provision of full pharmaceutical quantities of opioid on discharge from 29.4% to 6.1% (P < 0.001) and an increase in opioid weaning plans included in discharge summaries from 6.9% to 87.4% (P < 0.001). Conclusion: Raised awareness across the organization and education for staff more than halved the post-operative opioid prescription levels. This highlights the capacity for change in hospitals and the ability to work towards safer prescribing of post-operative opioid therapy.

Background: To understand patterns of opioid prescribing on discharge in the orthopaedic and neurosurgical wards of a tertiary metropolitan hospital. Methods: A retrospective audit of medical records and discharge summaries for all orthopaedic and neurosurgical patients admitted for at least 2 days on two surgical wards over a 6-month period between 1 January and 30 June 2017. Results: A combined total of 355 patients (281 orthopaedic and 74 neurosurgical patients) were included in the audit. Approximately 82% were discharged on opioids. Of patients discharged on opioids, 71.4% of the orthopaedic group and 73.8% of the neurosurgical group were discharged on combinations of two or more opioids (immediate release together with slow release). Around 65% of the sample discharged on opioids was opioid naïve on admission. About 32.5% of the orthopaedic patients and 68.9% of the neurosurgical patients were discharged on a combination of opioid and other pharmacotherapy that could potentiate the central nervous system depressant effect of the opioids. Only 6.9% of orthopaedic patients and 11.5% of the neurosurgical patients had discharge summaries that included any reference to opioid management after discharge. Conclusion: Orthopaedic and neurosurgical units had high opioid prescribing rates on discharge from hospital. This highlights the need for clear communication of the intended medication management plan post-discharge in order to minimize inappropriate and ongoing use of opioids post-surgery.

BackgroundTo address the opioid crisis, much work has focused on minimizing opioid supply to surgical patients upon hospital discharge. Research is limited regarding handover to primary care providers. The aim of this study was to evaluate the communication of post‐operative opioid prescribing information provided by hospitals to general practitioners (GPs).MethodsThis study comprised two components. First, a retrospective audit of discharge summaries for opioid‐naïve surgical patients supplied with an opioid on discharge was conducted to evaluate accuracy of opioid documentation and presence of an opioid management plan. Second, a survey was distributed to GPs to seek their opinions regarding adequacy of communication about hospital‐initiated opioids in discharge summaries, challenges experienced in opioid management and suggestions for improvement.ResultsDischarge summaries for 285 patients were audited. Twenty‐seven (9.5%) patients had no discharge summary completed. Of the remaining 258, 63 (24.4%) summaries had at least one discrepancy between the opioid(s) listed and the opioid(s) dispensed. Only 33 (12.8%) summaries contained an opioid management plan. From 57 GP‐completed surveys, 41 (71.9%) GPs rarely or never received an opioid management plan from hospital surgical units and 34 (59.7%) were dissatisfied/very dissatisfied with information provided about opioid supply and management. Qualitative responses highlighted difficulties GPs experience managing opioid treatment for post‐surgical patients after discharge, differing patient expectations and the need to improve communication at times of transition.ConclusionWhen opioid‐naive patients are discharged from hospital on opioids, communication from hospitals to GPs is poor. Future interventions should focus on strategies to improve this.

Objective EDs are a common source of prescription opioids on discharge. We explored opioid prescribing practices in an ED at a tertiary hospital in Victoria, Australia. Methods A retrospective audit over a 6 month period of patients discharged from the ED to the community with the maximum allowable quantities of prescription opioids. Results There was a total of 3301 patient‐episodes discharged with a prescription from the ED. Of these, 766 (23.2%, 95% confidence interval [CI] 21.8–24.6) were prescribed opioids, with over half discharged with the maximum allowable quantities of prescription opioids. Immediate‐release opioids were prescribed in 362 (85.8%, 95% CI 82.5–89.1) patient‐episodes, a combination of immediate‐release and slow‐release preparations were prescribed in 29 (6.9%, 95% CI 4.5–9.3) and 31 (7.3%, 95% CI 4.8–9.8) were prescribed as slow‐release opioids alone. Co‐prescription of other analgesia with opioids occurred in 152 (36.0%, 95% CI 31.4–40.6) patient‐episodes. Possible drug interactions between opioids and other medications were noted in 117 (27.7%, 95% CI 23.4–32.0) patient‐episodes. Discharge summaries were prepared for 360 (85.3%, 95% CI 81.9–88.7) patient‐episodes, but only 171 (40.5%, 95% CI 35.8–45.2) included a plan to address the opioids, be that an opioid‐weaning regimen, analgesia review or referral to a pain specialist on discharge. Conclusion Opioid prescribing was common in this ED, with almost one‐quarter of discharge prescriptions being for a prescription opioid. This audit highlights potential areas for practice improvement including review of the quantity of opioid tablets prescribed as well as an opioid plan on discharge from the ED.