Patients on opioid replacement therapy hospitalised with acute pain represent a clinical challenge and have poorer perioperative outcomes. There is limited evidence relating to acute pain management of this complex cohort. The primary objectives of this retrospective audit was to establish the number of patients who are admitted on opioid replacement therapy with an acute pain condition under surgical services and evaluate the management of these patients to determine consistency of pain management practices. Secondarily, we aimed to evaluate the documentation of opioid replacement therapy in clinical notes to determine adherence to operational protocols and record clinically relevant outcomes including infection or postoperative complication rates. Forty-four episodes of care for buprenorphine patients and 19 episodes of care for methadone patients were included. There was significant variability in inpatient opioid prescribing, including practice of dose modification, and there was high utilisation of additional opioids, although agent choice varied. Multimodal analgesia was utilised, especially following acute pain service review. There was an 11% readmission rate for complications of the initial presentation. Documentation at transitions of care was poor. There is a need for further clinical studies into specific acute pain management strategies, and their effect on clinically relevant outcomes, to guide consistent management practices.

A model of a pharmacist-led consultation clinic within a Persistent Pain Management Service (PPMS) has recently been implemented to improve accessibility to medication review, promote opioid stewardship and reduce high-risk medication-taking behaviours. This audit aims to determine the impact of a pharmacist on opioid de-escalation and the perceived value of pharmacist interventions. This audit was conducted at an outpatient PPMS between 30/10/19 and 25/3/20. Pharmacist interventions and deprescribing plans from 1:1 consultation with patients were communicated in writing to general practitioners (GPs) for actioning. Opioid consumption was quantified using oral morphine equivalent daily dose (oMEDD). Self-rated patient, GP and PPMS staff questionnaires were used to assess perception of value and impact of pharmacist service. Thirty-five patients were included. Mean oMEDD reduced from 86.2mg to 73.4mg (p < 0.0001) after a mean of 64 days. Pharmacist consultation resulted in improved patient understanding of medication roles in chronic noncancer pain (CNCP) (self-rated score: 6.4 increased to 8.0 on a 10-point scale, p < 0.0001) and improved confidence to safely administer medications (7.2 increased to 8.7, p < 0.0001). There was 100% patient satisfaction. GP questionnaire data (n = 18) indicated 90% of GPs plan to implement at least one recommendation. GP's indicated recommendations were valuable, practical and clear (rated 4.1, 4.1 & 4.4, respectively, on a 5-point scale). Pharmacist service was associated with reduced opioid intake and improved patient understanding regarding roles and harms of medications in CNCP. Pharmacist interventions were routinely implemented and valued by GPs.