Opioids for Acute Pain resource kit
SA Health is committed to ensuring the quality use of opioids for the treatment of acute pain to promote optimal patient outcomes. A resource kit has been developed to support healthcare professionals in the provision of effective and safe analgesia to patients with acute pain. These resources aim to guide best clinical practice, enhance the knowledge of both staff and patients in relation to opioids and assist health services in accreditation under the National Safety and Quality Health Service Standards (Standard 4.11 for Medication Safety).
Resources that have been endorsed for SA Health statewide use are provided below and additional resources will be added as they become available. The majority of resources are based on work undertaken by the Royal Adelaide Hospital (RAH) Opioid Working Party and this group is acknowledged for this important contribution. The resources sheets below have been endorsed by the SA Medicines Advisory Committee (SAMAC) for statewide use following stakeholder consultation. Modifications should not be made without appropriate authorisation.
Early effective management of acute pain is critical to reducing morbidity and preventing the development of chronic pain, particularly in the post-operative period and immediately following discharge from hospital. Immediate-release (IR) opioids such as oxycodone are commonly used in this situation and recommended in preference to slow-release opioid formulations.
Whilst being highly effective, many medicines used for the management of pain, particularly opioids have a high risk of side-effects when not used appropriately (for example dependence or respiratory depression). Opioids are consistently found to be one of the top ten high-risk medicines identified worldwide and one of the top three high-risk medicines identified in the SA Health Safety Learning System (SLS).
Guidelines for Prescribing Opioids on Hospital Discharge
SA Health has implemented a statewide guideline on Opioids: Prescribing on Discharge (PDF 245KB) to promote the safe, effective and appropriate prescribing of opioids. The guideline will apply to all South Australian hospitals and health services where patients are discharged with medications and includes the following considerations:
- appropriateness of prescribing an opioid on discharge
- determining the quantity of opioid to be ordered
- legal requirements of an opioid prescription
- required patient education
- communication to the primary care provider.
Information for patients given oxycodone for the short term treatment of acute pain*
SA Health recommends that this patient information sheet is provided to all patients discharged from hospital with immediate-release (IR) oxycodone for acute pain as an adjunct to counselling by a qualified healthcare professional.
The oxycodone patient fact sheet (PDF 97KB) contains information to improve patient understanding of oxycodone in acute pain management; particularly:
- the short-term nature of the treatment
- the importance of recognising increasing sedation as the best clinical indicator of early respiratory depression.
Other fact sheets about the short term treatment of acute pain include:
Discharge information for patients given sedative or opioid (morphine-like) medicines for day-stay procedures*
SA Health recommends that this patient information sheet is provided to all patients discharged from hospital after administration of sedative and/or opioid medications as an adjunct to counselling by a qualified healthcare professional.
The discharge sheet (PDF 83KB) contains information on the effects of opioids and sedatives and provide precautions regarding activities that should be avoided in the 24 hour period following discharge.
Oxycodone consumer medicines information
SA Health recommends that the an oxycodone Consumer Medicine Information (CMI) leaflet be made available to all patients prescribed oxycodone on discharge, in association with appropriate counselling.
CMIs contain reliable information on the safe and effective use of prescription and pharmacist-only medicines. Therapeutic Goods Administration (TGA) regulations require that the CMI be made available to patients either in the pack or in another manner that will enable the information to be given to the person to whom the medicines are administered or otherwise dispensed.
The following references are recommended reading for healthcare professionals involved in the prescribing, supply, or administration of opioids to enhance knowledge and understanding regarding opioids for acute pain management, prescribing patterns and current issues:
- Opioids, ventilation and acute pain management. PE Macintyre, JA Loadsman, DA Scott. Anaesth Intensive Care 2011; 39: 545-558.
- Opioids and acute pain management: what should happen after discharge from hospital? A/Prof P Macintyre, C Brown, S Morris. MedicSA November/December 2011
- Hospital Oxycodone Utilisation Research Study (HOURS). A Platis, T Wenzel. RAH Pharmacy Department 2011
- Leong M, Murnion B, Haber PS. Examination of opioid prescribing in Australia from 1992-2007. Internal Medicine Journal 2009; 39: 676-681
- National Drug and Alcohol Research Centre (2012). A Review of Opioid Prescribing in Tasmania: A Blueprint for the Future. Sydney: University of New South Wales.
- AIHW 2012. National Opioid Pharmacotherapy Statistics Annual Data collection: 2011 report. Drug treatment series no. 15. Cat. no. HSE 121. Canberra: AIHW
- Macintyre PE, Schug SA, Scott DA, Visser EJ, Walker SM, APM:SE Working Group of the Australian and New . College of Anaesthetists and Faculty of Pain Medicine. (2010) Acute Pain Management: Scientific Evidence (3rd edition). From Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine.