What is an opioid?
Opioids are a group of pain relief medicines that include drugs such as morphine, codeine, and oxycodone. Effective pain control is important for recovery from injury, surgery and illness. Opioids are particularly effective after procedures and surgeries.
Why is this important?
We found that there was no clear and standardised pathway on the appropriate assessment, management and monitoring of pain.
Feedback from consumers and results from a pain management audit on a surgical ward show that:
- Pain was not being regularly assessed and documented
- Life threatening side effects of opioids (especially after the use of patient controlled analgesia (PCA)) were not monitored as regularly as it could have been
- Regularly prescribed pain relief medicines were not always administered
- Some patients experienced inadequate pain control
- Some patients who experienced pain were not offered analgesia in a timely manner
- Patient controlled analgesia (PCA) is a patient controlled pump which allows them to control the amount of medication administered to manage their pain
What are we trying to achieve?
Our objectives are to:
- Develop a comprehensive pain management resource which provides clear guidelines on how to appropriately manage pain
- Improve the routine monitoring of pain and the effectiveness of pain relief
- Improve the monitoring of life threatening side effects when patients are self-administering opioids via a pain pump
- Ensure regularly prescribed pain relief medicines are always administered
- Ensure patients are offered additional pain relief medication when required
- Improve patients’ experiences of pain management
What have we done?
1. Resource development
- Developed and published a resource (paper and electronic) to provide staff with clear guidance on how to appropriately manage pain and prescribe, use and monitor opioids in a safe and timely manner.
- Updated existing hospital policies on the expectations for monitoring of life-threatening complications post-opioid use
- Co-designed with our consumers and staff a “Speak Up” patient information leaflet and process which encourage conversations about pain and opioid side effects
"Speak Up" patient information leaflet
2. Staff education
- Educational sessions provided for ward nurses on how to manage pain and monitor side effects
- Programme initiated for junior medical doctors to regularly attend Pain Team ward rounds with our pain management specialists to learn how to assess and manage pain better
3. Care standards
What can you do to help us?
It is OK to ask for help! SPEAK UP when you are in pain or if you experience side effects from your medicines.
It is easier to manage pain and side effects early. Let us know so we can help you more effectively manage and control your pain and side effects from medicines.
Did we make a difference?
Ward audits on pain management from Feb 2015 to Mar 2016 (n=117 patients) showed:
- The routine monitoring of pain has improved from 36% to 80% (median)
- The monitoring of life threatening side effects when PCAs were used has improved from 0% to 50% (median)
- The routine administration of regularly prescribed pain relief medicines has improved from 15% to 50% (median)
- The routine offering of additional pain relief medicines when the patient is in pain has improved from 36% 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 14% to 0% (median)
- The overall experience of pain management remain relatively unchanged from 90% to 87
Survey results of patient experience with pain management
Where to from here?
Work currently underway includes:
- implementing the “Speak Up” patient information leaflet on other wards, with some encouraging positive results already being shown
- trialling, for the first time in NZ, the inclusion of the “Speak Up” patient information leaflet as an educational resource for patients in our Patient Entertainment Systems on one surgical ward [view more about our Patient Entertainment Systems]
- Continuing to refine and implement our pain management educational resources and process
- Incorporating standardised pain management guidelines into nursing educational curriculum and ward accreditation standards
- Incorporating the lessons learnt and resources developed from the Safe Use of Opioid project to inform:
- our electronic vital signs monitoring (eVitals) project (eg when to alert clinicians when patients in pain, electronic prompts and clinical decision support to help clinicians make appropriate treatment choice) [view more about eVitals]
- our 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) [view more about electronic prescribing and administration]