Safe Use of Opioids Collaborative

With a view to enhancing the patient’s experience of pain management and reducing uncontrolled pain we aimed to:

1. Develop a comprehensive and foundational pain management resource which offers clear guidance on how to appropriately monitor and manage pain
2. Improve the routine monitoring of pain
3. Improve the monitoring of life threatening side effects when PCA’s were used
4. Ensure regularly prescribed pain relief medicines were always administered
5. Ensure patients are offered additional analgesia when in pain
6. Improve overall patients’ experiences of pain management

Our team have:

1. Developed and published a comprehensive and foundational educational resource to provide staff with clear guidance on how to appropriately manage pain and prescribe, use and monitor opioids in a safe and timely manner.
   
   
2. Updated existing hospital policies on the expectations for monitoring of life-threatening complications post-opioid use
   
   
3. Provided educational sessions for ward nurses on how to manage pain and monitor side effects  to ward nursing staff
   
   
4. Initiated a programme where junior medical doctors regularly attend Pain Team ward rounds with our pain management specialists to learn how to assess and manage pain better
   
   
5. Incorporated pain management standards which are aligned and consistent with the Patient and Whanau Care Standards Programme
   
   
6. Co-designed with our consumers and staff a “Speak Up” patient information leaflet and process which encourages conversations about pain and opioid side effects

Ward audits on pain management between 09 Feb 15 to 14 Mar 16 (n=117 patients) showed:

• The routine monitoring of pain has improved from 9% to 46% (median)

• The monitoring of life threatening side effects when PCAs were used has improved from 0% to 57% (median)

• The routine administration of regularly prescribed pain relief medicines has improved from 16% to 55% (median)

• The routine offering of additional pain relief medicines when the patient is in pain has improved from 40% to 80% (median)

Despite improvements in the monitoring and management of pain and encouraging staff to have meaningful conversations with patients about their pain and side effects:

• The overall rate of uncontrolled pain remains relatively unchanged from 13% to 16% (median)
  
  

• The overall experience of pain management remain relatively unchanged from 90% to 87%
  
  

Even though the Safe Use of Opioids Collaborative drew to a close in mid-2016, we will continue to work with our consumers and clinicians to improve better pain management and experiences of care.

For example, we have:

• incorporated the lessons from the Safe Use of Opioid project into:
  • the electronic vital signs monitoring (eVitals) project –pain scores and other monitoring parameters necessary for safe opioid use now mandated data fields
  • the electronic prescribing and administration (ePA) project (eg development of pain management pre-set orders for faster prescribing, co-prescribing of medicines which can be used to manage opioid side effects)
    
    
• started planning for further roll out of iPad Patient Entertainment Units
  
  
• started exploring how pain management plans can be routinely captured in electronic discharge summaries
  
  
• as part of Patient Safety Week 2017, looking into how we can more effectively encourage patients to speak up and ask about their medicines; especially for our Maori, Pacific and Asian patients