Whilst it is widely agreed that as a class of medicines opioids are extremely useful, as without them many modern treatments, particularly many surgeries, could not be performed, they can cause considerable harm.
Since 2014 the Health Quality and Safety Commission has been working with all New Zealand District Health Boards to deliver a nationwide collaborative designed to reduce harm from opioids in hospitals and to build capability within DHBs in medication safety and quality improvement.
The National Opioid Collaborative is based on the Institute for Healthcare Improvement (IHI) breakthrough series collaborative approach, which uses the Model for Improvement (rapid cycle testing using Plan-Do-Study-Act), and it recognises the uniqueness of each DHBs environment whilst facilitating best-practice sharing from around New Zealand and overseas. DHBs across the South Island DHBs are all taking an active role in this programme, with each DHB focusing on the area of opioid-related harm that is most important to their district. West Coast and Nelson Marlborough DHBs are focusing on reducing constipation, Southern DHB is focusing on post-operative nausea and vomiting, Canterbury DHB’s focus is uncontrolled pain while South Canterbury DHB’s focus is respiratory depression.
While it is recognised that each DHB is at a different stages of in terms of applying the collaborative methodology and their monitoring of opioid-related harm, all DHBs are participating in a set programme of activity which includes attendance at four national learning sessions, development of baseline data and strategic planning and implementation against which their efforts can be measured.
Kim Caffell is the Southern DHB Project Manager for the Opioid Collaborative and says she is seeing good progress in terms of their efforts to reduce opioid related harm locally: “Our overall aim is to reduce rates of post-operative nausea and vomiting (PONV) by 25% by March 2016. We have done a lot of work to understand the patient journey in relation to elective orthopaedic patients in order to look at interventions that are aimed at reducing the rates of PONV. We are well into identifying what the ongoing change we would like to see is, and are now working with various clinical teams to identify how this might happen. The key focus is to build any change into existing processes in a streamlined way, rather than look for another form or process. “Their efforts are seeing positive results already says Kim: “The concept is receiving positive feedback from clinical staff, and we are excited about the opportunities to see a sustainable change which improves the patient experience of care.”
Taking a different focus on opioid management is West Coast DHB. Staff there are working on reducing the harm associated with opioid-induced constipation and their goal is to reduce the incidence among inpatient surgical patients by 25% or more by April 2016. Mohammed Osman, Pharmacy Manager and Opioid Collaborative Project Manager at Greymouth Hospital explains that their approach has led to innovation in the prescribing of opioids: “To help us achieve a reduction in harm we used literature and the Plan-Do-Study-Act frameworks to implement the parallel prescribing of opioids with a regular laxative (Laxsol).” Their approach has been delivering positive results and they are now planning to roll this out to other areas: “The pathway to achieve our aim is clearer and we are in the stage of expanding this to other wards.”
Being part of a collaborative has real benefits according to Mohammed: “The national collaboration looks at the big picture, consequently results and work done won’t be exclusive to certain group or geographical areas. There is a great amount of experience transferred throughout the national collaboration, to the extent that it will influence the implementation of regional and local projects.”
The involvement of all five South Island DHBs in the collaborative is being supported by the Quality and Safety Group of the South Island Alliance, as Chair Mary Gordon explains: “Working as a collaborative is key to driving change as it enables DHBs to learn from each other in a collaborative environment, share their experiences and trialling improvements that will help feedback into shaping future practices for all DHBs. We know our members are working hard to support and promote the collaborative across the South Island and it is great to see DHBs developing resourceful solutions to their current opioid-related issues that will directly improve quality of care experienced by patients.”
The programme is being delivered until April 2016. For more information about the collaborative visit: http://www.hqsc.govt.nz/our-programmes/medication-safety/publications-and-resources/publication/1813/