177 Service evaluation on fentanyl use in a regional renal unit hospital

<h3>Background</h3> Fentanyl for symptom control at end of life is used variably in hospital inpatients around Wessex Deanery. It is not routinely available everywhere and there are no common guidelines for its use in hospitals where it is available. This is a service evaluation of current use of Fentanyl for symptom control in medical inpatients, in a 1,200 bed district hospital with a 49 bed specialist Renal unit. The data compiled will aid in creating a deanery-wide Fentanyl protocol. <h3>Method</h3> Data was collected retrospectively over a 12 month period, from the digital medicines team, on administrations of subcutaneous Fentanyl on wards. Patients and clinical details were looked up via digital notes, to determine the indications for Fentanyl use. <h3>Results</h3> Four patients received subcutaneous Fentanyl in a one year period for symptom control. All four patients received this as part of a syringe driver with or without additional as-required usage. All prescriptions were made by the specialist Palliative Care team, despite being available to prescribe for all prescribers on the wards. All patients had end-stage renal failure with an eGFR &lt;15. One patient received Fentanyl as the first opioid, the other three were switched by the Palliative Care team from another opioid prescribed by ward doctors to Fentanyl due to renal failure. <h3>Conclusion</h3> Very small numbers of patients are receiving Fentanyl at end of life, initiated only by the specialist Palliative Care team, despite being available to all prescribers. It is likely doctors are more familiar using alternatives such as Oxycodone. In a large trust with a specialist Renal centre, there will be many more patients who would benefit from Fentanyl as the initial opioid of choice at the end of life. Developing clear guidelines for on how and when to use Fentanyl would be beneficial and is currently being developed.