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Opioid Wisely: reducing ‘over-supply’ of opioids at hospital discharge

With the prescribing rates of opioids in Australia continuing to rise, the team from the Sir Charles Gairdner Hospital (SCGH) in Western Australia have developed a new guideline and discharge form to support best-practice Choosing Wisely principles in opioid prescribing.

Jill Kemp, Clinical Nurse Consultant Acute Pain Service, at Sir Charles Gairdner Hospital

A baseline audit of three high-opioid prescribing wards (general surgical, orthopaedic and an acute medical ward) identified 86 patients who were prescribed with opioids at discharge, most of whom were administered opioids in the 24 hours prior to discharge (92%) and were also prescribed simple analgesia (94%) on discharge. Of these patients, 61% of patients were opioid naïve on admission to the hospital, only 24% had an opioid weaning plan documented on the discharge letter and only 16% of patients were supplied quantities less than a full box of PBS medication.

As most patients were not discharged with the routine input of the specialised Acute Pain Service, the Discharge Analgesia Prescribing guideline was developed to support junior medical staff and pharmacists when completing or reviewing a patient’s discharge script. The guideline is condition specific and focusses on detailing the dose of medication, quantity supplied and considerations for simple analgesia options.

A bright green-coloured, easily recognised form was developed to integrate the discharge medication, dose, quantity supplied and the weaning plan for patients discharged with Acute Pain Service involvement. Hospital-wide education was then delivered explaining the update to all relevant prescribers and pharmacists in the hospital.

The team will assess the effectiveness of the guideline and the form at a future repeat audit, and both medical and pharmacy staff will be given an opportunity to provide feedback. In the initial phase of the program the team is focussing on patients with acute pain. A second stage will focus on people with chronic pain.

The team hopes to see improvements in opioid prescribing and to make their contribution to reducing the over-supply of opioids at hospital discharge.

Sustainability of this project will be achieved via analgesic stewardship encompassed within the North Metropolitan Health Service (NMHS) Diversion Prevention Project, integration of the information into orientation packages, and improved processes for communication between teams and to community General Practice.

Choosing Wisely opioid resource

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Managing pain and opioid medicines

A new resource for people who are prescribed opioids for non-cancer pain in hospital has been developed as part of the Choosing Wisely Australia initiative.

Hospital staff are encouraged to provide the two-page patient resource on managing pain and opioid medicines to people prescribed opioids for non-cancer pain as inpatients, or on discharge and encourage a conversation about opioids use for short-term pain, their adverse effects and other ways of managing pain.

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The Health Resource Stewardship for Clinical educators contains educational material about the Choosing Wisely initiative for use in universities, hospitals and health professional colleges

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