First opioid stewardship standard welcomed: Hospital Pharmacists key to its success
The Society of Hospital Pharmacists of Australia (SHPA) is pleased to welcome the first national Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard, which aims to minimise the risk of harm associated with the use of opioid analgesics for acute pain, which accounts for more medicine-related deaths in Australia than any other drug category.
Released today by the Australian Commission on Safety and Quality in Health Care, this new national clinical care standard, which outlines appropriate use and review of opioid analgesics for managing acute pain in acute care settings, is the first to support the opioid analgesic regulatory changes implemented by the Therapeutic Goods Administration in June 2020.
SHPA Chief Executive Kristin Michaels welcomed the new Standard, which supports recommendations outlined in SHPA’s landmark 2018 Reducing opioid-related harm report.
‘Among its 33 recommendations, SHPA’s report highlighted the need for care standards, patient-centred tools for self-assessment and management of pain, and the need for consumer health organisations to educate patients regarding managing pain expectations, so we are pleased to see these recommendations continue to be implemented.
‘The release of these Standards will further empower Hospital Pharmacists to reduce the inappropriate supply and dispensing of opioids, and to provide opioid medicine de-escalation and tapering plans at the point of discharge, so that primary healthcare providers and patients are supported to significantly reduce the potential for developing long-term misuse.’
Shania Liu, SHPA Pain Management Chair and Clinical Pharmacist at South Eastern Sydney Local Health District, say Hospital Pharmacists are essential in achieving acute pain clinical care standards.
‘As medicines experts working in acute settings, Clinical Pharmacists and Opioid Analgesic Stewardship Pharmacists are essential in minimising the risk of harm associated with opioid analgesic use.
‘When embedded in multidisciplinary teams they play a central role in reducing the risk of inappropriate medicine prescription, supply and use by applying their expert knowledge to recommend appropriate pain medicines selection and dosing to inform safe prescribing by doctors.
‘This is especially important during high-risk transitions of care between health settings such as Emergency Departments and Perioperative and Surgical Services.’
In its 2022–2023 Pre-Budget submission, SHPA called for Commonwealth funding of a National Opioid Stewardship Support Liaison program to reduce the risk of opioid-related harm for patients in Australian hospitals.
Ms Michaels says many Hospital Pharmacists are implementing innovative opioid stewardship activities into their daily practice, with some hospital sites already embedding dedicated services where funding is available.
‘Hospital Pharmacist-led opioid stewardship programs have been successfully trialled in Victorian and Queensland hospitals in recent years. In Victoria, pharmacist-led opioid de-escalation in orthopaedic patients reduced opioid requirements by 25%, while an opioid prescribing toolkit developed in Queensland contributed to reducing the average number of oxycodone tablets supplied on discharge from 20 to 11.
‘Such services need to be funded by all hospitals in partnership between state, territory and commonwealth jurisdictions, to ensure these clinical care standards can be met.’
SHPA will continue to collaborate with other healthcare practitioners and organisation to prevent unnecessary harm caused by opioids initiated in the hospital setting and will produce materials and education to support members over the coming months to implement this new Standard.
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Background
Appropriate use of opioid medicines has long been a key part of SHPA’s strategy to achieve better medicines safety and regulation.
In 2016 SHPA became the first pharmacy organisation to collaborate with Choosing Wisely Australia and released our five recommendations against the use of low-dose codeine, which formed part of our broad strategy to achieve better medicines safety and regulation. That same year, SHPA was the only pharmacy organisation to unequivocally support the proposal for the TGA to up-schedule medicines containing codeine.