The Opioid Prescribing Toolkit (OPT) was developed to provide information on how to utilise the tools developed and tested Royal Brisbane and Women's Hospital (RBWH) opioid improvement projects in other clinical settings. It includes instruction on pre-implementation planning strategies and evaluation tools. Whilst OPT is based on improving oxycodone prescribing it can be adapted for the prescribing of all opioids or specific opioids.
Opioid Prescribing Toolkit
Opioid Prescribing Toolkit provides a framework for introducing the concepts of opioid stewardship to acute settings.
Using a systematic approach consisting of practice and context evaluation to identify, prioritise areas for improvement will result in;
- Improved appropriateness of opioid prescribing.
- Improved patient education - expectations of pain management, use of simple analgesics and aperients.
- Improved clinical handover - communication general practitioners.
The exponential rise in opiate prescribing in Australia is well described, with a 15-fold increase in the past two decades. Opiate related harm continues to escalate (1-3) Evidence shows that the risk of long term opioid use increases dramatically in the first few days of new prescriptions, particularly if prescribed more than five days of therapy (4, 5).
There has been an increase use of oxycodone in an acute setting and preliminary data from RBWH indicated that the Pharmaceutical Benefits Scheme (PBS) quantity was frequently prescribed on discharge and that communication to the General Practitioner (GP) was often suboptimal.
We sought to improve prescribing practices by limiting prescribing to the number of doses patients required for analgesia and improving communication both to the patient and GP on discharge.
Subsequent to the successes at RBWH PBS in terms of change to practice the OPT was developed. OPT aims to provide information on how to utilise the tools developed and tested RBWH opioid improvement projects in other clinical settings. It includes instruction on pre-implementation planning strategies and evaluation tools. Whilst OPT is based on improving oxycodone prescribing it can be adapted for the prescribing of all opioids or specific opioids.
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
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.
- Administration TG. Prescription S8 opioid use and misuse in Australia – options for a regulatory response consultation paper. January 2018.
- Blanch B, Pearson S-A, Haber PS. An overview of the patterns of prescription opioid use, costs and related harms in Australia. British Journal of Clinical Pharmacology. 2014;78(5):1159-66.
- 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.