Objective: To describe the impact of an educational intervention for ED prescribers on discharge oxycodone prescribing both for the number of oxycodone prescriptions per 1000 discharged patients, and the number of tablets per prescription. Secondary outcomes included the quality of general practitioner communication. Methods: An interrupted time series assessment was conducted in the ED of a tertiary referral hospital to establish the pre-intervention, periintervention and post-intervention prescribing profile of ED medical practitioners. Prescriber numbers were used to obtain drug data for all oxycodone-containing prescriptions from the Queensland Health Medicines Regulation and Quality Unit database. The intervention included education sessions, a staff information email, posters within the ED, and a patient brochure. It was conducted with relevant nurses, pharmacists and prescribing doctors. Results: In the pre-intervention period, 656/17 371 (38 per 1000) discharged patients were prescribed oxycodone, compared to 180/5938 (30 per 1000) during the intervention, and 602/20 505 (29 per 1000) post-intervention. This equated to a decrease of 8 per 1000 (95% CI 5-12 per 1000) and a 22% (95% CI 13-31%) relative prescribing reduction. The mean total number of tablets of oxycodone per prescription decreased from 16.7 (SD 16.5) preintervention, to 12.7 (SD 6.0) periintervention, to 10.7 (SD 5.2) postintervention. After the intervention, there was an increase in discharge communications to general practitioners by 15.4% (95% CI 9.7-21.1%). Conclusions: An ED prescribertargeted intervention reduced overall prescribing of oxycodone and improved communication at discharge. The prescribing intervention is one strategy that may be used by ED medical staff to improve patient safety and opioid stewardship in Australia.

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Lag it M any patients with upper limb injuries are given a broad arm sling as part of their treatment. This is used for elevating, protecting, and supporting the injured limb. It is traditionally and cheaply made using a linen triangular bandage. When worn, the part of the triangular bandage that is supported by the neck forms a narrow band which patients often find uncomfortable. This is especially the case when part of the upper limb is made heavier with a cast. In our unit the Collar'n'Cuff versatile sling material made of 100% polyurethane foam is used to help pad the neck. Relief with this method is only short lived as the foam is of low density and has a tendency to slip off. A patient attended our fracture clinic using an alternative padding, made of copper pipe lagging, which allowed almost complete relief (fig 1). This is an ideal material, as it is made of a higher density foam and is comfortable, conforms to the shape of the neck, and stays in place.