Opening address: Safe use of opioids national collaborative

Tēnā koutou katoa, welcome to collaborative team members who have come together, for the first time from across New Zealand, to create a national network aiming to  reduce opioid-related harm in our hospitals.

As Associate Minister of Health, it is my pleasure to be here with you all this morning to open learning session one, the Collaborative’s inaugural national event. The next two days will be an excellent opportunity for collaborative teams to come together to learn about systems thinking and quality improvement methodologies and tools, to share experiences, and to network with each other. This learning session is part of a process that supports your collective efforts to ensure every patient ngets the best and safest healthcare they deserve - and in particular, lead to improvements so people are not harmed by the very medicines that are meant to help them.

Context and background

The safe use of opioids national collaborative is an important component of the Health Quality & Safety Commission’s three-year-long focus on reducing harm from high-risk medicines. The high-risk medicines focus is one of four key workstreams within the Commission’s medication safety work programme, which is committed to reducing patient harm.

The opioid collaborative is aligned to the Commission’s strategic priorities which are underpinned by the New Zealand Triple Aim, in particular, improving the quality, safety and experience of patient care. The Commission was established in 2010 to ensure that all New Zealanders receive the best health and disability care within available resources.

The vast majority of New Zealanders receive safe and high quality care. However, unfortunately, a small number of patients and consumers are harmed while receiving health care in hospital as in-patient or out-patients, in community-based health facilities, and in their own homes. This includes harm related to the medicines they are taking, including opioids.

Internationally, the greatest harm from opioids occurs from illicit misuse and addiction. Although New Zealand does not have the same level of opioid misuse and addiction as some other countries, anecdotal evidence suggests that prescription opioid abuse is increasingly common. However, the greatest amount of opioid-related harm occurs in health care settings, particularly involving opioids used to alleviate pain.

Opioid-related harm in hospitals

Opioids are known high-risk medicines – errors are likely to cause significant patient harm. Opioids such as morphine and fentanyl play an important role in relieving pain and discomfort within in-patient settings, especially around the time of surgery – they are a useful and essential part of the care we provide.

They are prescribed and administered widely; from neonatal to surgical units, right through to care of the elderly services. But, every day, patients of all ages are exposed to the real and significant risks from the use of opioids in our hospitals, and sometimes harm occurs.

This harm is often avoidable.

Harms may occur in specific clinical settings such as acute surgical wards, but hospital systems may also create circumstances that increase the chance of harm, in particular during the transfer of care between different health services.

Recently an 82 year old patient with kidney impairment was prescribed high-dose oxycodone to take home. Very sadly, two days later they were found unresponsive in their home, and then died due to complications associated with opioid toxicity.

This is an example of why special effort is needed to protect vulnerable people from opioid harm. We need to take a close look at discharge processes and consider what hospitals can do to prevent such tragedies.

Atlas of Healthcare Variation

The Commission’s Atlas of Healthcare Variation recently published information on opioids giving clinicians, patients and providers an overview on their district health board’s use. Of every 10 people dispensed a strong opioid in the community, nearly half attended a public hospital as an inpatient or outpatient in the week prior. This suggests a public hospital ‘trigger’ that led to the prescribing and dispensing of a strong opioid.

We need to consider whether this high rate of opioid dispensing is related to prescribing behaviours, or to clinical factors such as acuity or disease state.

Collaborative approach

While it is important to acknowledge the interface between in-patient and other settings, the immediate priority is the high rate of opioid-related harm identified in our hospitals. This is why the Commission’s Board and Medication Safety Expert Advisory Group chose this class of medicines to be the specific focus of this collaborative.

Opioids were also identified as a priority area because there is no universally accepted bundle of evidence-based interventions available that can reduce opioid-related harm. Because of this, the Collaborative’s approach will be ‘formative’ in nature - the challenge for you is to test interventions, and to identify the ones that demonstrate proven reductions in opioid-related harm, which can then be shared nationally.

Meaningful and measureable interventions are needed that will make a real difference to reducing harm to patients. When planning your work, consider how you will actively involve consumers. Also consider how your work aligns with the strategic framework in Medicines New Zealand – in particular, the strategy’s ‘optimal use of medicines’ outcome, and principles relating to equity, effectiveness and value for money.

We know from the experience of other collaboratives that partnership and team work can improve the care we give our patients. Many of you will be familiar with the central line associated bacteraemia or CLAB collaborative, which delivered impressive improvements in infection rates, and the Enhanced Recovery after Surgery (ERAS) collaborative. The success of the opioid collaborative depends on many things, including the participation of collaborative teams at these learning sessions, which is why it is so very pleasing to see such a high level of attendance here today.

Capability building

The opioid collaborative is not just a partnership between the Commission, public hospitals and other key stakeholders to reduce harm, but also a vehicle for building capability in quality improvement within the 20 district health boards.

The next two days will build on the knowledge gained at learning session zero; this session will provide you with the skills and knowledge that are needed for testing interventions in your workplaces, during the first ‘action period’, and beyond this collaborative for future quality improvement work in your district health boards.

I encourage you to make the most of this meeting, and the collaborative journey in general. It is a tremendous opportunity to share and learn. Always bear in mind the main goal: providing the best and safest care to New Zealanders.