Opioid Prescribing Safety Audit

This project audits whether opioid prescribing is clinically justified, proportionate, reviewed and safely documented. It reviews indication and pain assessment, opioid status, prescription detail and PRN limits, review, stop or taper plans, risk factors including renal, frailty, respiratory and sedative co-prescribing, bowel care and monitoring, controlled-drug requirements, counselling and dependence discussion, discharge quantity and duration, medicines reconciliation and transfer-of-care communication.

• Doctors, nurses, pharmacists, pharmacy technicians, ACPs and PAs prescribing or reviewing opioids
• Acute pain, perioperative, surgical, acute medicine and emergency teams
• Primary care, community, care-home and hospice clinical teams where locally included
• QI leads, medicines optimisation, governance and patient safety teams
• Supervisors and educators supporting ARCP and appraisal evidence

• Measure whether opioid indication, assessment and opioid status are documented
• Assess prescription clarity, PRN limits, review dates and stop or taper plans
• Review risk factors, sedative co-prescribing, bowel care and monitoring
• Test discharge quantity, counselling, reconciliation and GP communication
• Generate governance-ready and ARCP-ready evidence and a re-audit cycle

• Anonymous case identifier
• Inclusion / eligibility decision
• Anonymised context (age band, sex/gender recorded, care setting, prescribing context)
• Clinical area / location and optional specialty / service
• Twenty-one opioid prescribing safety criteria (met / not met / not applicable)
• Free-text learning points and any project custom fields

• Live dashboard
• Audit report (Word)
• Executive summary (Word)
• Excel workbook
• PowerPoint presentation
• Conference poster
• ARCP evidence summary

This ready-built project is developed using the guidance, standards and authoritative sources listed below, so you can see what is being measured and why. Lazomis QI does not publish or own this guidance, and inclusion here does not imply endorsement or approval by any of these organisations.

• NICE

  NG215: Medicines associated with dependence or withdrawal symptoms(opens the original source in a new tab)

  Safe prescribing, review, shared decision-making and withdrawal management for dependence-forming medicines including opioids.

• NICE

  NG193: Chronic pain (primary and secondary) in over 16s(opens the original source in a new tab)

  Applies where chronic primary pain or chronic pain prescribing is within the local project scope.

• MHRA

  Drug Safety Update: Opioids — risk of dependence and addiction(opens the original source in a new tab)

  Regulatory advice on discussing dependence and addiction risk, agreeing a treatment strategy and planning review and withdrawal.

• Faculty of Pain Medicine / Royal College of Anaesthetists

  Opioids Aware(opens the original source in a new tab)

  Resource for prescribers on indication, dose, review, tapering and patient information in acute, perioperative and long-term opioid use.

• NICE

  NG5: Medicines optimisation(opens the original source in a new tab)

  Medicines review, reconciliation and safe transfer of medicines information across care settings.

• Local policy

  Local opioid, controlled drugs, discharge prescribing and monitoring policies

  Local opioid prescribing, acute and chronic pain, controlled drugs, discharge opioid SOP, postoperative analgesia, renal/frailty analgesia, bowel care, monitoring, deprescribing, naloxone, substance-misuse pathway, ePMA documentation and medicines reconciliation policies define doses, thresholds, quantities, review intervals and documentation locations. Confirm local policy before setting targets.

• Designed to use anonymised or pseudonymised audit identifiers.
• This tool supports, but does not replace, clinical judgement.
• Local policy, formulary and specialist advice should be followed.
• Organisations remain responsible for local governance arrangements.
• This tool supports documentation and prescribing-safety review only. It does not provide patient-specific prescribing, opioid conversion, tapering, withdrawal management or pain-management advice.
• Doses, oral morphine equivalent thresholds, conversion ratios, tapering schedules, duration limits and monitoring frequencies are locally configured and are not presented here as national standards.
• Use anonymous case identifiers only — never patient-identifiable information.

Supporting guidance from the Lazomis QI Resource Library. Authoritative clinical standards referenced by this project remain separate.

• Clinical GovernanceLeveraging Incident Themes for Quality Improvement and Patient SafetyThis guide helps NHS teams identify and analyse recurring incident themes, transforming reported safety events into practical quality improvement opportunities to enhance patient safety and system reliability.
• Clinical GovernanceIntegrating Quality Improvement into Clinical Governance FrameworksThis article explores the vital relationship between Quality Improvement (QI) and Clinical Governance within the NHS, demonstrating how they are two sides of the same coin when aiming for continuous, systematic improvement in patient care.
• Patient SafetyIntegrating Patient Safety and Quality Improvement: A Practical Guide for UK CliniciansThis guide explains the foundational principles of patient safety and quality improvement (QI) within the UK healthcare context, offering practical strategies for clinicians to enhance safety and improve care delivery.
• Patient SafetyHow to Select a Patient Safety Quality Improvement ProjectThis guide helps NHS teams identify and select patient safety quality improvement (QI) projects that are impactful, achievable, and aligned with organisational and national priorities. Learn how to move from identifying concerns to choosing a focused and measurable project.