A new paper from the SHPA has exposed national inconsistencies in provision of pharmacy services to reduce the risk of opioid misuse
“These tablets, they’re not lollies,” outgoing president of the Society of Hospital Pharmacists of Australia, Professor Michael Dooley, told Fairfax Media.
Yet the SHPA’s new paper, the first Australian study to comprehensively analyse current hospital pharmacy practices around opioids, shows that more than 70% of hospitals “frequently” supply opioids for patients to take home “just in case” – even if they have not required them in the 48 hours prior to discharge.
The paper, Reducing opioid-related harm: A hospital pharmacy landscape paper, highlights the urgent need for a coordinated multidisciplinary approach, says the SHPA.
It used data from an online survey of hospital pharmacists in both the private and public sectors, across 135 heatlh facilities.
It also shines a light on the extremely high rate of use of such sustained-release opioids – with 77% of hospital pharmacist respondents saying they were used for treating acute pain, despite this going against advice from ANZCA and Therapeutic Guidelines: Analgesic.
Prof Dooley says SHPA aims to start an important conversation about hospital services, hoping to collaborate with other health professionals and organisations to prevent unnecessary harms from opioid initiated in the hospital setting.
“This work highlights that current practices in hospitals relating to the prescribing and dispensing of opioids at discharge are resulting in quantities in excess of patient need, which has the potential to lead to preventable harm,” he said.
“We found clinical pharmacy services are often unable to prioritise surgical patients being discharged and these patients are not having an appropriate review of their medication.
“Consequently, as identified in this report, more than 70% of hospitals frequently supplied opioids for patients to take home ‘just in case’, even when they have not required them in the 48 hours prior to discharge.
“Also of significant concern, pharmacists reported extremely high use of sustained-release opioids in the treatment of acute pain for opioid-naive surgical patients.”
He told Fairfax Media that as a result, people frequently stockpile such medicines, with an end result of misuse.
“Patients can end up on a lifelong journey of addiction a a result of being given opioids when they don’t need them,” he said.
Prof Dooley says implementation of opioid stewardship programs is insufficient and disparate across Australia.
“Our findings reveal less than 5% of hospitals have formal opioid stewardship programs, which are showing good progress in reducing unnecessary opioid supply, and even fewer have invested in other innovative responses to address this growing problem.”
Less than 10% of pharmacist respondents provided opioid de-escalation plans at discharge.
One in five respondents said their hospital had no acute pain service.
And 93% of respondents indicated their hospital pharmacists were either never able to, or unable to, routinely attend ward rounds on to advise on analgesic medicines, including opioid use, alongside the patient’s care team.
“This insight gathered by SHPA members adds enormous impetus to consolidate and expand efforts already underway to reduce opioid harms in six key areas: working with prescribers, engaging patients, supporting opioid stewardship, managing medication supply, supporting transitions of care between the hospital and the home and empowering pharmacists as medicines experts.”
The paper makes a number of recommendations, including empowering pharmacists to work at their fullest scope of practice, supporting transitions of care – including supporting the inclusion of pharmacists in the completion of hospital discharge summaries for patients leaving the hospital – and working with prescribers.
The paper also recommends language change, suggesting the word “painkillers” be replaced with “medicines for reducing pain” to reduce confusion and manage expectations among patients.
The release of the paper has been welcomed by pharmacy stakeholders.
"Just in Case" just #notacceptable – this puts pressure on GPs and pharmacists in primary care to deal with the consequences of this #prescribing – thankful to @the_shpa for shining a light on one of the causes @PSA_National https://t.co/TZokYFh4CR
— Shane Jackson (@ShaneJacks) November 25, 2018
Whilst harm minimisation initiatives such as RTPM @SafeScript will be crucial for informed clinical decision making with prescribing+dispensing, it’s critical that theres best practice prescribing at initiation of therapy backed by evidence. Many cases of dependency avoidable https://t.co/Ncu53xFfsM
— Anthony Tassone (@A_Tass1) November 26, 2018