Opioid tool kits reduce over prescribing

October 2019

Thanks to an EMF research grant, the Royal Brisbane and Women’s Hospital (RBWH) is leading the way in reducing opioid prescribing following a 12-month intervention which saw a 21 per cent relative reduction in opioid prescriptions for emergency department patients at discharge.

This equates to an average decrease of six tablets per prescription.

The ‘Opioid Prescribing Toolkit’ focuses on changing prescribing culture from the ground up by equipping clinicians with the knowledge to discuss and facilitate non-pharmacological strategies with patients, only prescribing opioids as a small part of an overall pain management strategy, if at all.

A recent Australian Institute of Health and Welfare (AIHW) report suggests that across Australia, as many as three deaths, 14 emergency department presentations and 150 hospitalisations each day are related to opioid use.

The RBWH research project was led by a team of frontline Emergency Department clinicians in response to this increase in opioid prescribing across Australia.

RBWH Quality Use of Medicines Pharmacist, Champika Pattullo said the ‘Opioid Prescribing Toolkit’ is designed to be effective without adding large volumes of additional work for clinicians.

“Pain is not unique to any one area of medicine or group of patients – it is universal, so having a good understanding of approaches to pain management, including discussing non-pharmacological strategies with patients, is vital,” she said.

“The Toolkit aims to educate clinicians that opioids are only a small part of managing pain and that often, other methods can and should be used to reach the optimal patient outcome.

“Opioid Stewardship is all about finding the balance between providing good pain management and avoiding unintended harm.”

Following the introduction of the Toolkit, the results have shown a significant shift towards tailored prescribing of opioids and the quantity supplied, as well as improved quality and quantity of medical handover to GPs.

The toolkit has been endorsed by the Queensland Clinical Senate and is now being expanded to 14 other sites with 25 local teams across the state.

Ms Pattullo acts as a facilitator to help build local teams, adapt the Toolkit’s resources, and build the momentum for sustainable Opioid Stewardship.

“If we want to empower each hospital to take ownership of the program and run it independently, we must address their unique needs, investigate the culture and build local implementation teams that will champion and drive change,” Ms Pattullo said.

“We are currently developing a Quality Improvement Framework in the Emergency Department at RBWH to sustain and build on the success of the intervention. We hope to facilitate this tailored and sustainable framework across Queensland to provide patients with a consistent standard of care and safety no matter where they live.

“The hardest part of any change or quality improvement is getting started, and this trial and the Toolkit means the hurdle is much smaller.

“As momentum in Opioid Stewardship builds across the state, I foresee better and safer pain management for all Queenslanders.”

Several local teams are already taking on the Toolkit model outside of the Emergency Department setting, with projects emerging in Paediatrics, Maternity, Surgery and Medical wards.

Combined with the resources to appropriately monitor, evaluate and re-evaluate along the way, the project is on track to become a sustainable model that can be applied to other clinical settings across Australia.

The EMF research grant for this project was funded by Queensland Health.


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