Search

The Stewardship Framework (Framewor k) was developed by an expert clinician group and was designed to provide a mechanism for continuous monitoring of improvement in opioid prescribing in acute hospitals. The aim of this study was to modify the Framework into an Opioid Stewardship Self-Assessment Tool (Self-Assessment Tool), and pilot test the acceptability and its use in a variety of acute hospital settings. The Framework was converted into the Self-Assessment Tool to allow hospitals to undertake a gap analysis of their current opioid stewardship activities. To participate hospitals were required to establish a small team and complete the Self-Assessment Tool. Participating sites were recruited using purposive sampling. Responses were tabulated and coded to enable assessment. 'Acceptability' was defined as the completion of the Self-Assessment Tool (response rate, proportion of questions answered) and responder feedback relating to its content. The use of the Tool was categorised based on the level of detail of responses. Nineteen of the 20 facilities approached, agreed to participate. The 16 sites which established a small team to facilitate survey completion are included in the final analysis. The overall response rate was 96 % (413/432) for the (27 survey questions across 16 participating sites), 4 % (19/432) of questions were left unanswered or were not interpretable by the study team. Opportunities were identified to enhance the use of the Self-Assessment Tool , particularly to support its potential to assist reflection and planning of local strategies. This study demonstrated that the Self-Assessment Tool was an acceptable method of assessing a facility's opioid stewardship capabilities in a real-world setting. The next iteration will be modified using the insights on how the Tool was used by study participants. [ABSTRACT FROM AUTHOR]

Objective: This study provides an overview of opioid dispensing in Queensland from 2008 to 2018 by recipient age, drug, oral morphine equivalent and remoteness. Methods: Data were obtained from the Queensland Monitoring of Drugs of Dependence System database for 2008–18 and analysed using data from the Australian Bureau of Statistics to account for population growth. Opioid dispensing by age, drug, oral morphine equivalent and remoteness were assessed. Results: The number of prescriptions for Schedule 8 opioid medicines dispensed in Queensland increased from 190 to 430 per 1000 population over the study period (2.3-fold increase). Oxycodone had the largest increase in dispensing over the study period of 3.1-fold, with tapentadol increasing rapidly since initial Pharmaceutical Benefits Scheme listing in 2013 to the third most dispensed opioid by 2018. By 2018, opioid dispensing among the oldest Queenslanders, those aged 85+ years, occurred at triple the rate for those aged 65–84 years. When adjusted to report oral morphine equivalents (OME) in milligrams (mg), there has been an increase of approximately 1.9-fold over the study period. Results were also presented by geographical area, including a heatmap and analysis by remoteness. Prescriptions dispensed per 1000 population were 416 for major cities, 551 for inner regional and 445 for outer regional, and highlight that inner and outer regional areas have higher rates of prescriptions when compared to major cities (32 and 7% higher, respectively). Conclusion: This study highlights changes in opioid prescription dispensing by drug and OME, as well as the variation in dispensing rates when accounting for remoteness. Further studies to link statewide databases, and to better understand drivers for differences in dispensing by location, will provide valuable insights to further inform policy and service provision. What is known about the topic? Opioid dispensing is known to have increased in Australia over recent decades. However, most existing data hails from the Pharmaceutical Benefits Scheme (PBS), which has small gaps in quantifying opioids that are not subsidised. What does this paper add? This retrospective study uses an alternative database, adding information about non-PBS dispensing of tapentadol and buprenorphine, accompanied by rates of opioid dispensing in Queensland by age, oral morphine equivalent and geographical area. What are the implications for practitioners? This research highlights recent changes in opioid dispensing and opportunities for further studies to best inform practice improvement. [ABSTRACT FROM AUTHOR]

Objective. This systematic review identified studies that provided an estimate of persistent opioid use following patient discharge from hospital settings in Australia. Methods. A literature search was performed on 5 December 2020, with no date restrictions to identify studies that reported a rate of persistent opioid use following patient discharge from Australian Hospitals. The search strategy combined all terms relating to the themes 'hospital patients', 'prescribing', 'opioids' and 'Australia'. Studies that dealt solely with cancer, palliative care or addiction medicine were excluded. The databases searched in this review were Embase, PubMed, Scopus, CINAHL, and International Pharmaceutical Abstracts. Studies were assessed for bias using the Newcastle-- Ottawa Scale and considered against international literature. Results. In total, 13 publications are included for final analysis in this review. Of these, 11 articles relate to post-surgical opioid use. With one exception, studies were of a 'good' quality. Methods of data collection in included studies were a mixture of those conducting follow up of patients directly over time and those utilising dispensing databases. Persistent opioid use among surgical patients generally ranged from 3.9 to 10.5% at between 2 and 4 months after discharge. Conclusions. How rates of persistent opioid use following hospital encounters in Australia are established, and how long after discharge rates are reported, is heterogeneous. Literature primarily relates to post-surgical patients, with very few studies investigating other settings such as encounters with the emergency department. [ABSTRACT FROM AUTHOR]

There is growing interest in strategies to improve patient safety with prescription opioids, collectively known as opioid stewardship (OS). This study aimed to develop a framework to facilitate the implementation of OS in the Australian acute hospital setting. Using a Modified Delphi Technique, a diverse stakeholder panel (including patient representatives and multidisciplinary healthcare professionals) was selected. A survey based on the results of a literature review was sent to the panel for appraisal. In line with standard Delphi methodology, the primary outcome for each element was reaching consensus of at least 70% of the participants on the importance of its inclusion in the framework. The survey allowed the participants to suggest new items for inclusion in subsequent rounds or rephrase existing items. Of the 29 participants who completed the survey, the majority (23/29) were regularly involved in providing direct patient care. Twenty‐six of 27 items reached the 70% threshold for agreement for importance after the first round. The remaining item not agreed on in the initial round was modified based on comments received and reached 100% agreement on importance at the second round. There was greater than 85% agreement on importance of 24 of 27 items for inclusion in a framework with 8 of 27 reaching a 100% level of agreement. We have developed a framework for OS in the Australian acute hospital settings that may be used to guide health services to prioritise and plan strategies to improve opioid use. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article discusses standard practice in pain management for pharmacy services. Topics include the society of hospitals pharmacists of Australia (SHPA) standards for clinical pharmacy services in pain management; the pain management pharmacist on providing of facilitates multidisciplinary management of pain and treatment; and develop the pharmacy workforce through the training and education of pharmacists.