Opioid medicines are frequently used to treat moderate to severe pain and maintain anaesthesia. Opioid medicines principally act on opioid receptors in the central and peripheral nervous systems (mainly gastrointestinal tract), producing effects including analgesia, respiratory depression, sedation and constipation.
Errors involving opioids can include:
- Administration of an incorrect formulation. For example, administration of a short acting formulation when a long-acting formulation was intended (and vice versa).
- Failure to adjust an opioid dose according to patient factors. For example, pain assessment, biochemistry, renal function, age, opioid tolerance and drug interactions with other medicines.
- Dose calculation errors when transitioning between different opioid medicines, formulations or routes of administration.
- Inappropriate use of opioid patches, including the use of fentanyl patches for patients with acute pain who are not opioid tolerant. Other errors involving opioid patches include prescribing and applying patches at the incorrect time interval, cutting or only partially applying patches and failing to remove a patch before applying a new patch.
The Opioid Standard of the NSW Health High-Risk Medicines Management Policy (PD2020_045) outlines the minimum actions required to reduce risks associated with opioid medicines. The Opioid Standard includes a risk management strategy and addresses opioid prescribing, storage, supply, administration and patient information and education.
In facilities where hydromorphone is in use, the High-Risk Medicines Management Policy Hydromorphone Standard must be implemented in addition to the Opioid Standard.
The tool below can also be used to assist hospitals in monitoring risks associated with opioids. It can also be used to monitor local implementation and compliance with the Opioid Standard of the High-Risk Medicines Management Policy.