13 Prescribing for pain and symptom management in hospital patients with advanced liver disease: a single centre, retrospective clinical audit

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Background and Aims Advanced liver disease patients require adjustments to dose of medications as per the British Association for the Study of the Liver (BASL) guidelines. In this study, we assessed whether prescribing adhered to BASL guidelines and if this changed following intervention by Supportive and Palliative care Team (SPCT). Method Prescribing data were collected retrospectively from the electronic prescribing system at a UK tertiary liver centre over 5 months (April–August 2024). Data were reviewed against BASL guidelines to determine if meeting standards prior to and after SPCT review. Results 30 patients (50% male) were included with a median age of 64.5 and mixed aetiologies (53.4% alcohol-related, 20% metabolic dysfunction-associated steatotic liver disease). 70% of patients sampled (n = 21) had oral paracetamol prescribed, of which 43% met the BASL standard (2–3g daily). SPCT intervention was statistically significant, reducing the dose (p <0.05). For oral morphine (n = 12) patients meeting recommendations (2.5mg 4–6 hourly) increased from 18% to 36%. With subcutaneous morphine (n = 10) 80% of patients met standards (1.25–5mg hourly). 12 patients were prescribed oral oxycodone with an increase in standards adherence (1.25mg 6–8hourly) after intervention from 8.3% to 33.3%. Metoclopramide was prescribed in 6 patients, and none met BASL standards (5mg 8hourly) prior to referral but 50% of patients adhered after. All prescriptions of intravenous and oral ondansetron (n = 7) were higher than recommended BASL doses (8mg daily) however, no prescription was changed. Conclusion Adherence to standards varies greatly between drug and route but overall shows a lack of adjustment accounting for liver disease severity, but with trends of improvement post SPCT review. Although safe at reduced dose, paracetamol is not prescribed for all patients. Initial findings indicate the need for development of local prescribing resources that would improve patient safety.

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