Opioid Prescribing Toolkit

Initiative Type
Toolkit
Status
Deliver
Added
11 December 2018
Last updated
05 May 2020

Summary

The initiative is multifaceted and involves key stakeholder contribution, quality improvement activities and education. It is a prescriber-led continuous quality improvement, which incorporate outcomes of practice audits into educational interventions for their peers and adopt changes in their own practice.

Practice improvement is the result of both heightened awareness and self-reflection and therefore is not limited to a specific opioid but extends to other analgesia and general pain management. In addition to practice improvement in pain management, an increase in the general quality improvement capability and capacity of the frontline clinicians is a by-product of this methodology.

This process is supported by a local multi-disciplinary team formed through consultation/facilitation by the QOSP Team. The local team consists of a clinician lead (typically Registrar or SMO), as well as a team of senior medical staff, pharmacists, nursing and allied health involved in providing care for patients within the department. This team support a cycle OOPPS in their department through:

  • Participation in project meetings and one-on-one catch-ups (with both local and QOSP teams)
  • Lead decisions around QI steps to follow the baseline audit
  • Review of developed education materials
  • Provide updates and feedback to the QOSP Team about project status and progress
Key dates
Oct 2017
Implementation sites
The Royal Brisbane and Women’s, Redcliffe, Caboolture, Prince Charles, The Princess Alexandra, Bundaberg, Gold Coast University, Sunshine Coast University, Rockhampton, Logan, Mackay and Townsville Hospitals
Partnerships
Caboolture ED, Redcliffe ED, Redcliffe Opioid Stewardship Team

Aim

To implement structured programs of quality improvement to ensure the safe and effective use of opioids in pain management across Queensland Hospitals.

Benefits

  • Facilitated implementation of Optimising Opioid Prescribing ProgramS (OOPPS) in Emergency Departments using Opioid Prescribing Toolkit (OPT) methodology.
  • Rational prescribing of oxycodone which is tailored to the needs of the patient, not standard or full-box quantities. It is expected this will manifest in a reduction in overall quantity of opioids (but specifically oxycodone) prescribed on discharge from the ED.
  • Improved pain management and reduce likelihood of unintended opioid-related harm by providing patients with the appropriate pain management plans and medication education.
  • Reduced number of patients re-admitted to hospital because of accidental poisoning due to a prescription opioid.
  • Socialisation of of Opioid Stewardship at a facility level by showcasing successes of the ED.
  • Builds Quality Improvement capacity and capability in the front-line clinical workforce.

Background

The Optimising Opioid Prescribing ProgramS (OOPPS), first piloted at Royal Brisbane and Women’s Hospital (RBWH) Emergency Department (ED), demonstrated significant improvements in the quality of opioid prescribing and communication to general practitioners. From this program, the Opioid Prescribing Toolkit (OPT) was developed to provide a framework for introducing the concepts of opioid stewardship to any acute care setting. Using OPT to facilitate an OOPPS cycle, similar improvements have also been achieved at the Caboolture Hospital ED, and in RBWH Surgical units.

OOPPS represents Phase 1 of the QOSP in any setting and is facilitated by the QOSP Team. The QOSP team have extensive experience in the Quality Improvement and in developing and implementing OPT and OOPPS interventions. This team, which consists of clinicians and supported by a multidisciplinary reference group is ideally placed to assist and guide local teams action change at the front line of patient care. Local teams can feel supported through the OOPPS process in their department and provide a starting point for OS activities within their facility. Local teams assist the movement towards Statewide OS by contributing their results, experiences and resources to future OOPPS cycles across the state, and to publications which may help shape OS efforts across Australia.

Evaluation and Results

The Outcome Report for OPT Phase 1: OOPPS-ED will be delivered in December 2020. It will include outcomes for all sites who have actioned OOPPS using the OPT in their ED.
Key indicators will include:

  • Number of sites to undertake an OOPPS cycle in ED using OPT methodology.
  • Reduction in proportion of patients discharged on oxycodone.
  • Reduction in oxycodone quantity (duration of treatment) of discharged patients.
  • Decrease admissions secondary to opioids.
  • Improved quality of medical handover to GPs.
  • Evidence of the spread of Opioid Stewardship within each facility. For example, OOPPS in other areas such as Surgery, establishment of an analgesic steering group (or similar), development of analgesic prescribing or discharge guidelines.

References

  1. Administration TG. Prescription S8 opioid use and misuse in Australia – options for a regulatory response consultation paper. January 2018.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

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Key contact

Champika Pattullo
Quality Use of Medicines Pharmacist / CEQ Improvement Fellow
Metro North Hospital and Health Service
(07) 3646 3217
Champika.Pattullo@health.qld.gov.au