Building on the safe use of opioids national formative collaborative
Opioid medicines (morphine, oxycodone, fentanyl, methadone, tramadol, codeine) are high-risk medicines, which are excellent at controlling pain but have several unintended side-effects (eg, nausea, vomiting, constipation, urinary retention). Opioids can also cause serious harm when given in high doses, or in individuals who are at higher risk (eg, opioid-induced ventilatory impairment [OIVI] and arrest).
Opioids are a leading contributor of health care associated harm ranging from patients experiencing mild distress to substantial patient harm and increased costs to hospital services in New Zealand. In response to these concerns, the Health Quality & Safety Commission sponsored an eighteen-month formative collaborative, aimed at building district health board (DHB) hospital and private hospital engagement and capacity to identify interventions to reduce opioid harm.
Starting in October 2014, the collaborative was based on the Institute for Healthcare Improvement’s (IHI) breakthrough-series collaborative methodology. Frontline hospital staff engaged in small-scale, rapid cycle testing of ‘change ideas’ to reduce opioid-related harm.
The collaborative produced three best-practice bundle elements (opioid induced constipation [OIC], opioid induced ventilatory impairment [OIVI] and uncontrolled pain) and a composite care bundle. The how-to guide describes the four emerging care bundles designed to reduce opioid-related harm. The term ‘emerging’ is used because, although some evidence from the individual interventions indicates they are effective, no evidence yet exists to show improvement when the interventions are used together.
The implementation package builds on the work of the formative collaborative to refine those elements with the most evidence, to test, implement, spread, embed, and sustain as business as usual, in the participating hospitals. The use of standardised definitions and data collection across sites will enable the use of these data at an aggregated national level.
Work by the national safe use of opioids group builds on this earlier activity.
What are we trying to accomplish? Our aim is to reduce the harm from the therapeutic use of opioids in New Zealand hospitals.
Aim: To reduce opioid-related harm (specifically OIC and OIVI) in adult surgical inpatients (eg, general surgery, orthopaedics, urology, transplant) by 25 percent in participating hospitals within 12 months.