Opioids are a class of medicines that include morphine, methadone and oxycodone. Opioids have a number of benefits, but their use can be associated with adverse events and are known to cause harm to patients.

For this reason, the Health Quality & Safety Commission partnered with district health boards (DHBs) in a national opioid collaborative from October 2014 to June 2016.

The goal of the collaborative was to reduce harm from opioids in DHB hospitals and build capability in medication safety and quality improvement.

An expert faculty, including palliative care specialists, pain practitioners, anaesthetists, and medication safety and quality improvement specialists, identified a range of potential opioid-related harms and measures. These were collated for DHB collaborative teams to review and are available from the link below.

The collaborative also involved four learning sessions to support local DHB teams and build knowledge on the methodology, as they tested possible interventions that might reduce the harm from opioid use. See below for the resources from the learning sessions.

An intensive testing phase was carried out in early 2016, with DHBs testing the proposed interventions. The collaborative work continued to the end of June 2016, including measurement and identifying interventions for a bundle of care to reduce opioid-related harm.

An evaluation of the Commission-led Safe Use of Opioids National Formative Collaborative was undertaken in November 2016. The overall results of the Collaborative have been positive and have demonstrated improvements in quality improvement capability, medication safety processes, and opioid-related harm reduction. See resource link below to download the report.

The areas of harm focussed on were opioid-related; constipation, ventilatory impairment (respiratory depression), uncontrolled pain, and nausea and vomiting. Some teams sought to change / improve discharge processes around opioid prescribing to reduce harm in the community setting.

There were 17 teams that participated in the collaborative. The results for 12 teams were able to be analysed (five team’s results were excluded because a baseline was not established). 
  • Seven hospitals showed a greater than 25 percent reduction in opioid-related harm, with 6/12 exhibiting a special cause in SPC chart.
  • Two hospitals showed a 0-25 percent relative reduction (one with special cause).
  • Three hospitals showed a relative increase in harm (no special cause).

Three individual harm bundles have been developed (an opioid-induced constipation, opioid-induced ventilatory impairment and uncontrolled pain) along with an over-arching composite care bundle (the How-to guide). 

We look forward to the next phase of building on these results and supporting the sector to use the bundles of care that have been developed. The learning from the next phase will be incorporated in a future edition of the bundles.

Last updated 30/08/2018