Objective: An audit of opioid prescribing in a large teaching hospital across all specialties was conducted to identify areas for improvement.Methods: Opioid medications prescribed for the entire patient admission were recorded and assessed using quality statements.Results and Discussion: Of 334 patients reviewed 209 (62.6%) were prescribed an opioid. Poly-prescribing of 'when required' (p.r.n.) opioids was frequent with 107 (51.2%) patients having more than one 'p.r.n.' opioid. Dosing intervals were too long for 146 (69.8%) patients leaving them at risk of breakthrough pain. The intramuscular route was prescribed for 100 (47.8%) patients, and 49 (23.4%) of prescriptions had an inappropriate variety of administration routes.Conclusion: Although the criteria for assessing opioid prescribing were stringent the prescribing was sub-optimal. This survey will form the basis for future quality initiatives.