Objectives and Background Intravenous morphine is commonly used in the Emergency Department (ED) and is often prescribed with a dose range from 1 to 10 mg to allow for administration to be titrated to pain. Accurate documentation of the actual dose given or multiple doses given under a single prescription is a legal requirement and is particularly important for a controlled drug. Inadequate documentation may lead to over- or under-dosing, poor handover from ED staff to wards/theatres and raises issues of patient safety, clinical effectiveness and potential medico-legal consequences. We aimed to assess documentation of morphine administration within the ED and evaluate methods for improving practice.

Methods Documentation of morphine prescribing was reviewed against pharmacy guidelines for a baseline sample of 1200 attendances to our department over a 1-month period. Following staff re-education and protocol dissemination the review was repeated prospectively. After the second review a prescribing sticker was introduced, prompting documentation of the number, dose and timing of morphine boluses given to satisfy each variable dose prescription. A third prospective review was performed.

Results Overall, 3600 ED attendances were investigated over the three reviews. In 172 cases the drug chart included a variable dose prescription of intravenous morphine. The baseline review showed the actual dose of morphine administered was documented in only 66% of cases. Following re-education and protocol dissemination adherence to pharmacy guidelines rose to 89% and after the introduction of prescribing stickers this increased further to 98%.

Conclusions The use of a simple drug chart modification and re-education has been shown to improve the documentation of morphine administration to a near perfect level within the ED. Accurate prescribing of controlled drugs is essential and methods such as this can be easily employed to improve patient safety and quality of care.