National Guidelines of Opioid prescribing for acute pain

In the last few years we have noticed there has been a growing number of requests for expert opinions concerning the oversupply of prescription opioids. 

A significant step toward combatting these  alleged harms and even premature deaths associated with opioid analgesic prescribing has been made with the release by the Australian Commission on Safety and Quality in Healthcare, of a nationally agreed Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard. The standard which comes into effect in March 2022, relates to the safe prescribing of opioids on discharge following surgery and by Hospital Emergency Departments.  

Whilst the full report runs to some 58 pages a useful summary can be found below.

Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard (acute care edition) 

1. Patient information and shared decision making 

The nonpharmacological and pharmacological options for managing acute pain are discussed with a patient and their carer in a way that they can understand, and that leads to a shared understanding of the decision to use an opioid analgesic or other treatment(s). 

2. Acute pain assessment 

Analgesic prescribing for a patient with acute pain is guided by its expected severity and assessment of patient-reported pain intensity and the impact of pain on the patient’s function. 

3. Risk–benefit analysis 

Whenever an opioid analgesic is considered for a patient with acute pain, their risk of opioid-related harm is assessed. An opioid analgesic may be prescribed when other analgesics are not clinically feasible or sufficient, and the potential benefits outweigh the potential harms. 

4. Pathways of care  

A patient with acute pain prescribed an opioid analgesic who is at increased risk of opioid-related harm is appropriately managed in conjunction with a locally approved pathway to mitigate the potential for harm. 

5. Appropriate opioid analgesic prescribing 

If an opioid analgesic is considered appropriate for an opioid-naïve patient with acute pain, use an immediate-release formulation at the lowest appropriate dose, for a limited duration, in line with best practice guidelines. Modified-release opioid analgesics cannot be safely or rapidly titrated and their use in acute pain should be exceptional and not routine. The patient is supported to cease any opioid analgesic use as their function and pain improve. 

6. Monitoring and management of opioid analgesic adverse effects 

When an opioid analgesic is prescribed, supplied or administered for a patient with acute pain, adverse effects are monitored and managed. The patient and carer are made aware of potential adverse effects and signs of overdose, including respiratory depression. 

7. Documentation 

When a patient with acute pain is prescribed, supplied or administered an opioid analgesic, the intended duration of therapy, and the review and referral plan are documented in the patient’s healthcare record. The cause of the pain for which the opioid analgesic is prescribed is documented, including on the inpatient prescription. 

8. Review of therapy 

During hospital care, a patient prescribed an opioid analgesic for acute pain is assessed regularly to determine their response to therapy and whether an opioid analgesic is effective and appropriate for their stage of care. 

9. Transfer of care 

Planning for appropriate analgesic use at the transfer of care begins when a patient is started on an opioid analgesic during their hospital visit, according to an agreed opioid analgesic weaning and cessation protocol. The number of days’ supply of an opioid analgesic on discharge is based on multiple factors, including the expected course of the patient’s condition, appropriate arrangements for follow-up and opioid analgesic use in the last 24 hours before discharge. 

The full report can be accessed here.

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National Guidelines of Opioid prescribing for acute pain

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