The Opioid Prescribing Toolkit (OPT) was developed to mitigate some of the risks surrounding opioid prescription through consultation, and the identification of internal champions. It also minimises the administrative burden of developing protocols, education, posters and leaflets at individual sites.
Opioid Prescribing Toolkit
Provide a suite of tools which is adaptable across clinical settings and sites, and simplifies and supports the process of quality improvement.
- Improved appropriateness of opioid prescribing.
- Improved patient education.
- Improved clinical handover - communication to general practitioners.
In a landscape of increasing opioid use, misuse and harm, it is important for the hospital setting to provide consistent messaging about pain management and opioid prescribing to clinicians and patients alike.
Summary of Royal Brisbane and Women's Hospital Experience
Goals of practice
- Individualise care – setting expectations of pain management, utilising simple analgesia, use of aperients.
- Improve clinical handover – de-escalation plans to GP.
- Provide patient education – written and verbal.
Emergency department, Surgery
Utilising content experts and internal champions;
- Practice evaluation and context assessment (leadership, culture, barriers and enablers).
- Education – included results of the practice evaluation.
- Consensus based guidelines.
Note- the content experts and internal champions had direct involvement on all aspects of the initiative.
Summary of RBWH Outcomes
Statistically significant improvement has been demonstrated in the RBWH Emergency Department, with 85 per cent of oxycodone prescriptions now for <10 tablets (35 per cent prior to intervention), an effect which has been sustained over time. Other ED sites (Caboolture, Prince Charles, Redcliffe, Mackay and Townsville) are at varying stages of the intervention process. With Caboolture demonstrating sustainable change to >90 per cent prescriptions for <10 tablets (30 per cent prior to intervention).
Plan for OPT evaluation
It is anticipated this project will result in improved appropriateness of opioid prescribing, patients will receive appropriate education including use of simple analgesics and aperients, and communication to general practitioners will improve.
In addition to these clinical and service outcomes, we will measure a set of implementation outcomes to analyse and evaluate the use of OPT in different settings. These will include adoption, acceptability and appropriateness, fidelity, and sustainability.
The Opioid Prescribing Toolkit has proven to be a translatable and scalable approach across various hospitals. This has implications for a far-reaching improvement process, and provides an opportunity from which to springboard further Opioid Stewardship activities within Queensland.
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- Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths--United States, 2010-2015. Morbidity and Mortality Weekly Report. 2016;65(50 51):1445.
- Hoppe JA, Nelson LS, Perrone J, Weiner SG. Opioid Prescribing in a Cross Section of US Emergency Departments. Annals of Emergency Medicine. 2015;66(3):253-9.e1.
- Shah A HC, Martin BC. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017(66):269-5.