What is the 'Safe Use of Opioids Collaborative'?
The 'Safe Use of Opioids Collaborative' is a national project to reduce harm from opioids in New Zealand public hospitals led by the Health Quality and Safety Commission (HQSC).
What is an opioid?
Opioids are a group of pain relief medicines that include drugs such as morphine, codeine, and oxycodone. Effective pain control is important for recovery from injury, surgery and illness. Opioids are particularly effective after procedures and surgeries.
What are we trying to achieve?
Opioids can cause harm even when used appropriately but the risk increases when they are not, eg from under or overdosing or if the patient is not monitored adequately. The harm from inappropriate opioid use can be potentially life-threatening (although this is rare). More commonly, harm includes inadequate pain control, nausea, vomiting and constipation.
Research suggests that opioids are the most common class of medications implicated in patient harm. The reduction of harm associated with opioid use is a priority for improvement.
Our aim is to investigate how well opioids are being used and to work with our consumers to reduce opioid related harm by 25% by May 2016.
What did we find?
We audited the pain management of 113 surgical patients over 11 weeks and found that[1,2,3]:
- 10% experienced inadequate pain control
- Of patients who experienced pain, only around 40% were offered additional analgesia (pain relief) in a timely manner
- Only around 30% of patients on opioids were regularly monitored for potentially life-threatening complications of opioid use such as over-sedation
- 4% of patients felt hospital staff did not do everything they could to help control their pain
We also found that there was no clear and standardised pathway on the appropriate assessment, management and monitoring of pain.
What have we done?
With a view to reduce harm from opioid use we have:
- Developed and published an educational resource to provide staff with clear guidelines on how to appropriately manage pain and prescribe, use and monitor opioids in a safe and timely manner
- Updated existing hospital policies on the expectations for monitoring of life-threatening complications post-opioid use
- Developed an audit tool to assess opioid use and monitoring, to help identify areas in need of further enhancement and to track progress of improvement initiatives
- Co-designed with our consumer advocate a patient survey to understand their experience of pain management while in hospital
Where to from here?
We will continue to work with our consumers and clinicians to improve better pain management care. We are planning to:
- continue to refine and roll-out our pain management educational resource and policies
- continue to monitor pain management on our wards to help patients recover faster
- co-design with our consumers a patient-specific pain management care plan to achieve best outcomes for our patients
- National Patient Experience Survey 2014-2015. Health Quality and Safety Commission (HQSC).
- Pain management and monitoring in a surgical ward project audit (2015). Waitemata DHB Safe Use of Opioids Collaborative group.
- Pain management in medical wards project audit (2013). Edmeades, K.; Prasad, S.; Ross, S.