Developing a framework for implementing opioid stewardship programmes in Australian hospital settings

Abstract

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.

Opioid stewardship program implementation in rural and critical access hospitals in Arizona

“…The number of recommended stewardship elements ranges from eight 23 to 27. 33 Studies also diverge in their understanding of stewardship and conflate OSPs with other opioid interventions. Interventions that focus on reducing opioid exposure within specific populations like pediatric appendectomy patients 34 or pediatric patients with perioperative pain 35 are important, but they are too limited in scope to be labeled as OSP programs.…”

Recording and communicating opioid adverse drug reactions is an important element of opioid stewardship

“…in their recent publication have developed a framework to facilitate the implementation of opioid stewardship programmes in the acute hospital setting. 1 An important element of the safe prescribing of opioids is an understanding of opioid adverse drug reactions (ADRs) and the prescribing restrictions imposed by opioid ADR alerts in the electronic health record (EHR). Therefore, we would advocate for the framework to contain a subsection on the reporting and critical evaluation of opioid ADRs and the management of patients with an opioid ADR history.…”

Opioids caught in the crosshairs: Towards smarter and safer use of opioids in daily clinical practice

“…Several programmes have been trialled with limited success, indicative of the complexity of the problem. 29,32 –34 Despite the lack of proven approaches, opioid stewardship is still considered a valuable adjunct to prescriber and consumer education. 22,35…”

“…Several programmes have been trialled with limited success, indicative of the complexity of the problem. 29,[32][33][34] Despite the lack of proven approaches, opioid stewardship is still considered a valuable adjunct to prescriber and consumer education. 22,35 While strategies to improve the transitional care arrangements for people discharged from hospital acute care on opioids remain to be optimised, inhospital care has also been under scrutiny.…”