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<h3>Background</h3> Patients on the respiratory ward often have painful and life-limiting conditions requiring accurate and appropriate analgesia. These patients can require oral morphine for symptomatic management. The fundamental basis of prescribing analgesia is the WHO analgesic ladder.<sup>1</sup> This recommends prescription of non-opioid analgesia alongside oral morphine. Renal function should also be assessed when prescribing oral morphine and not prescribed when eGFR<30 according to national guidance.<sup>2</sup> This study aimed to review safety of oral morphine prescribing and adherence to the WHO analgesia ladder in the respiratory ward of a district general hospital in Scotland. <h3>Methods</h3> A retrospective audit of the clinical notes, online drug chart and eGFR of patients prescribed oral morphine on the respiratory ward across a 5-day period. 19 patients fit the patient criteria. Adherence to the analgesia ladder was only assessed in patients prescribed oral morphine for pain management. <h3>Results</h3> 32% of patients were admitted to the hospital already prescribed oral morphine in the community. The indications for prescription of oral morphine were for different symptomatic management: 74% pain, 10% for breathlessness and 16% for pain and breathlessness. Of the patients prescribed oral morphine for pain, 76% of these patients were prescribed regular or PRN non-opioid pain relief alongside oral morphine. Of note zero patients were prescribed an NSAID alongside oral morphine. 5% of patients prescribed oral morphine had an EGFR of <30. <h3>Conclusion</h3> This audit highlighted a variation in adherence to the WHO analgesic ladder and monitoring of renal function when prescribing opioids. Clinicians should aim to prescribe non-opioid analgesia with oral morphine when appropriate. Renal function should be monitored for patients prescribed opioids. The results of this audit were presented to the respiratory team FY1 to consultant level with an aim to improve safety and adherence to guidelines of oral morphine prescribing in the respiratory ward. <h3>References</h3> National Institute for Health and Care Excellence. Analgesia: mild to moderate pain – choice of analgesic [Internet]. Clinical Knowledge Summaries; [cited 2025 Oct 09]. Available from: https://cks.nice.org.uk/topics/analgesia-mild-to-moderate-pain/management/choice-of-analgesic/ Right Decisions for Health and Care. Acute pain [Internet]. Adult Therapeutic Guidelines, TAM (Treatments and Medicines), NHS Highland; [cited 2025 Oct 10]. Available from: https://rightdecisions.scot.nhs.uk/tam-treatments-and-medicines-nhs-highland/adult-therapeutic-guidelines/acute-pain/