Developing and piloting an adaptable oxycodone quality improvement strategy: steps towards opioid stewardship
Champika Pattullo A G , Benita Suckling A B , Sally Taylor C , Jonathan Thomson D , Gareth Collins E , Lisa Hall F and Peter Donovan AA Clinical Pharmacology Department, Royal Brisbane and Women’s Hospital, Clinical Pharmacology Department, Level 1 Ned Hanlon Building, Butterfield Street, Herston, Qld 4006, Australia. Email: peter.donovan@health.qld.gov.au
B Pharmacy Department, Redcliffe Hospital. Anzac Avenue, Redcliffe, Qld 4020, Australia. Email: Benita.Suckling@health.qld.gov.au
C Emergency Department, The Prince Charles Hospital. 627 Rode Rd, Chermside, Qld 4032, Australia. Email: Sally.Taylor@health.qld.gov.au
D Emergency Department, Caboolture Hospital. 97/120 McKean St, Caboolture, Qld 4510, Australia. Email: Jonathan.Thomson@health.qld.gov.au
E Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Qld 4006, Australia. Email: Gareth.Collins@health.qld.gov.au
F School of Public Health, University of Queensland. Herston Campus, 266 Herston Rd, Herston, Qld 4006, Australia. Email: l.hall3@uq.edu.au
G Corresponding author. Email: champika.pattullo@health.qld.gov.au
Australian Health Review 45(3) 353-360 https://doi.org/10.1071/AH20262
Submitted: 22 September 2020 Accepted: 27 October 2020 Published: 5 February 2021
Abstract
Objective In recent years, there have been considerable increases in both the utilisation and reported harms of prescription opioids in Australia. This report details the development of adaptable resources, implementation and the evaluation of pilot projects that optimise oxycodone prescribing and introduce concepts of opioid stewardship into hospital settings.
Methods An adaptable suite of resources, based on principles of implementation science, was developed and used to facilitate the projects. Local prescribing practice audits of oxycodone guided the development of context-sensitive educational strategies that were piloted and evaluated in a repeat audit. The primary outcome was the proportion of oxycodone prescriptions indicating tailored prescribing practices. In emergency departments (EDs), a prescription was considered tailored if it was for ≤10 tablets. In surgery, tailored prescriptions were those given to patients who had required opioids in the 24 h before discharge.
Results Cumulative results of the pilot projects in three EDs demonstrated improved rates of tailored oxycodone prescribing on discharge (62% vs 90%; P < 0.0001). In the surgical setting of one hospital, tailored prescribing increased significantly (from 76% to 91%; P = 0.013) and was accompanied by a halving of the proportion of patients receiving oxycodone prescriptions (36% vs 18%; P < 0.001).
Conclusions The implementation of facilitated, adaptable, prescriber-led quality improvement projects significantly improved tailored oxycodone prescribing practices and provides a platform to advance further opioid-related practice improvement in Australia.
What is known about the topic? The increasing trend in opioid prescribing, misuse, harm and death in Australia, and the potential for hospital prescribing to contribute to long-term opioid use, is well known. Recent changes to the Pharmaceutical Benefits Scheme are designed to help better identify patients who need oxycodone on discharge and the quantity to prescribe, rather than default prescribing. However, how to implement tailored prescribing has not been described in detail in the Australian literature.
What does this paper add? This paper adds to the mass of literature describing the ‘problem’ of opioid prescribing by providing a ‘solution’ in the form of evidence for the implementation of a facilitated and adaptable quality improvement strategy in emergency and surgical settings. The focus is not on a reduction of opioids, but rather on providing tailored pain management and opioid prescribing.
What are the implications for practitioners? This paper provides a practical, pragmatic and achievable starting point for other Australian practitioners to adapt the described processes and take the first steps towards opioid stewardship in their setting.
Keywords: hospitals, opioid, opioid stewardship, pain management, pharmaceuticals, quality and safety.
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