Queensland Opioid Stewardship Program (QOSP) supports the development, implementation and evaluation of opioid-focused practice improvement programs across Queensland Health. The program, still in its early stages, uses a Quality Improvement Program in conjunction with data analytics and the Opioid Stewardship Framework to help deliver customised programs to each hospital or clinical settings.
To implement opioid stewardship programs that achieve the dual goals of providing adequate analgesia while avoiding the unintended harms across Queensland Health hospitals.
There has been substantial Australian research into hospital-based strategies in response to the increased awareness of opioid-related safety risks and escalating opioid prescription.
“Stewardship” defined as “the act of taking care of or managing something” is a frequently used term in healthcare, most commonly in relation to antimicrobials (antimicrobial stewardship, AMS) and increasingly related to opioids.
In a broad sense, Opioid Stewardship (OS) has been described as “coordinated interventions designed to improve, monitor, and evaluate the use of opioids to support and protect human health”, but how this definition translates to a structured and actionable OS program in practice in Australian hospitals is not clear.
An opioid-focused practice improvement program, Optimising Opioid Prescribing ProjectS (OOPPS), was endorsed by the Queensland Clinical Senate in 2018. The Queensland Opioid Stewardship Program (QOSP) - Phase 1, was developed following a 12-month HIU funding scheme to implement OOPPS in eight Emergency Departments (ED).
OOPPS is based on a successful prescriber-led practice improvement program piloted in the ED of the Royal Brisbane and Women’s Hospital (RBWH). This pilot resulted in 21% relative reduction in total oxycodone prescriptions and improvements in clinical handover on discharge (Kline 2019). It subsequently led to the development of the Opioid Prescribing Toolkit (OPT) - a resource that can be used to replicate the project in other settings.
The QOSP team facilitates partnered sites to undertake an OOPPS cycle through the establishment of local teams led by a Senior Medical Officer.
The Intervention
In its first year QOSP far exceeded exceptions by not only implementing OOPPS in eight Emergency Departments (EDs), but also in other clinical settings.
July 2020-June 2021 represents QOSP Phase 2 which is again funded for 12 months through HIU. The aim for this phase is to
In addition to the formal part of the program collaboration with Queensland Children’s Hospital (QCH) and Queensland Child and Youth Clinical Network (QCYCN) has resulted in the development of strategic resources aimed at improving opioid prescribing in this population.
Lastly, a research initiative (not funded though QOSP) has been undertaken to development of a framework for opioid stewardship. When finalised, this framework will provide a starting point for considering opioid stewardship strategies in Australian hospitals and a platform from which to develop programs specific to unique clinical areas within hospitals.
The scaling of OOPPS and an evaluation of projects that were the first to be completed after the original ED pilot show:
Opioids play a central role in pain management in acute hospital settings, especially after surgery and trauma.However, there are concerns regarding the appropriateness and the volume of opioid prescriptions on discharge, and that opioids are often prescribed in excess of need. Reducing the over-prescription of opioids have multiple harm-reduction benefits, including reducing the risks of long-term dependency and reducing opportunities for the diversion of unused tablets to non-medical use. QOSP provides pragmatic strategies to improve patient safety.
