As of 2019, Australia ranks eighth internationally on the number of defined daily doses of prescription opioids1. Annually, this results in approximately 55,000 hospitalisations and 5000 emergency department presentations involving opioid harm across the nation2. This has a generational impact that can be difficult to appreciate on an individual bases. Thus, as healthcare providers, we have a duty
to share the importance of analgesia prescribing to our staff members and community alike. On 4 November 2021, Mackay Base Hospital (MBH) held its inaugural Opioid Stewardship Day to promote the safety of simple analgesia and opioid prescribing.
MBH is a major regional hospital in Central Queensland that encompasses Mackay, Isaac regions and the Whitsundays. It has seven operating theatres and a total of 318 beds. MBH is constantly adapting to the growing population of the region, and in 2021 there were approximately 5000 General Surgical, Orthopaedic, Obstetrics and Gynaecology surgeries. Moreover, the Anaesthetics department incorporated regional anaesthesia in almost 11% of the procedures. Our Anaesthetic Department and the Acute Pain Service (APS) team truly value and strive to provide exceptional peri-operative care for our patients.
Opioid Stewardship Day was a natural extension of the daily teamwork conducted by the surgical and anaesthetics department at MBH. The event was organized for the entire hospital staff, from medical practitioners to allied health and hospital maintenance staff. We were thrilled to create an engaging environment for everyone to participate in learning activities which facilitated the promotion of safe opioid prescribing.
The preamble to the day
The inaugural event was divided into several teaching sessions throughout the day, with the main attraction being the lunch in the hospital courtyard.
We presented the three month trend in the hospital prescribing data to various surgical departments during morning handover where junior doctors, registrars, and consultants were in attendance. Our main point of emphasis was towards the junior doctors who have the greatest responsibility with opioid prescribing during a patient’s hospital journey. We highlighted the prescribing habits from the surgical wards and suggested some areas of improvement. An important question that was discussed involved the amount of opioid prescribed at time of discharge. We advised that an ideal analgesia regime would include coverage for three to five days post discharge based on the last 24 hour of opioid requirement they had in the hospital. Furthermore, a large emphasis was placed on GP follow-up and a multidisciplinary patient care model.
The importance of multidisciplinary involvement was further highlighted by the innovative tea-trolley teaching initiative which was adapted from the “Bath tea trolley training” by Corbett and Davies3. This first of its kind initiative in Central Queensland, involved a 15-minute session allowing for an engaging discussion on appropriate analgesia and consolidated the concepts covered in earlier teaching. Most importantly, it encouraged multidisciplinary involvement, an innovative teaching method as highlighted by the NHS system4.
Upon conclusion of the tea trolley experience, hospital staff made their way to the main attraction in the hospital courtyard. A barbeque lunch with an array of stalls promoting various modalities to decrease opioid prescriptions, competitions with exciting prizes to be won and educational conversations by senior physicians. A mid-day break to meet like-minded individual's while discussing important issues surrounding opioid stewardship was well attended by nursing, medical and allied health staff alike.
Moreover, our luncheon was filled with relevant resources for the staff to learn about regional anaesthesia. At MBH, we endeavour to perform regional anaesthesia to its fullest extent and decrease the use of opioids. Ultrasound workshops were created to show attendees the appropriate set-up techniques for regional blocks. An interactive team building exercise, “Pin the block”, was used for dermatome education. This was especially well received by the audience as it resonated with the concept of alternative management techniques to alleviate post-operative pain.
A reflection on promoting clinical awareness
From a trainee’s perspective, Opioid Stewardship Day created a shared learning and teaching experience across different health professions and strengthened the sense of community within the hospital. As we continue to prepare for future events, some improvements we can make include creating a detailed schedule at least four to six months prior. This includes dedicated roles in seeking sponsorships, marketing the event, designing the learning stations, and creating the targeted teaching sessions. Whilst COVID-19 has been a particularly difficult time across the nation, its advent has taught us the importance of utilizing online meetings to carry out monthly updates to further assist in adhering to the schedule.
Through dedicated time and teamwork, MBH has successfully facilitated the learning of opioid prescribing by using various educational modalities. We accomplished this with the personalized presentations to the surgical departments, tied together by tea trolley teaching and luncheon in the communal area. These activities facilitated a common ground for staff to learn about opioid prescribing and regional anaesthesia. The event formed a non-judgemental space that encouraged discussion with specialists around the objectives we covered. Ultimately, the event allowed us to identify keys to successful promotion of clinical awareness. This included staff engagement, providing educational training sessions, and creating a common ground for an interactive discussion.
Acknowledgements
We would like to thank Belinda Johnston, APS RN, for her efforts in organizing the event. We would also like to thank Dr. Danny Bartlett, Dr. Suresh Singaravelu and Dr. Shane Gardiner for their support throughout the event. Lastly, we would like to thank Dr. Shreyas Boppana and Mackay Institute of Research and Innovation (MIRI) for assisting through the data collection period.
Written by Dr Sabrina Chan and Dr Vishav Gill (Anaesthetic Resident Medical Officers).
References
1. Opioid harm in Australia and comparisons between Australia and Canada. 2018. 1st ed. [eBook] Canberra: Australian Government: Australian Institute of Health and Welfare, p.viii. Available at: <https://www.aihw.gov.au/reports/illicit-use-of-drugs/opioid-harm-in-australia/summary> [Accessed 2 February 2022].
2. Addressing prescription opioid use and misuse in Australia: Regulatory Impact Self-Assessment Report. 2019. 1st ed. [eBook] Therapeutic Good Administration, p.4. Available at: <https://www.tga.gov.au/publication/addressing-prescription-opioid-use-and-misuse-australia> [Accessed 4 October 2021].
3. Corbett, L. and Davies, A., 2020. "Bath Tea Trolley" Training Part One. Bulletin: The magazine for the members of the Royal College of the Anaesthetists, [online] (119), pp.28-30. Available at: <https://www.rcoa.ac.uk/sites/default/files/documents/2019-10/19-145-Kelly_table.pdf> [Accessed 15 December 2021].
4. Basheer, H., Allwood, B., Lindsell, C., Freeth, D. and Vaux, E., 2018. Never too busy to learn: How the modern team can learn together in the busy workplace. 1st ed. [eBook] London: Royal College of Physicians. Available at: <https://www.rcplondon.ac.uk/projects/outputs/never-too-busy-learn-pandemic-response-0> [Accessed 7 December 2021].