Health Quality Ontario’s Opioid Prescribing for Acute Pain Quality Standard provides guidance on the appropriate prescribing, monitoring, and tapering of opioids to treat acute pain for people 15 years of age and older in all care settings.
The quality standard includes 10 quality statements addressing areas that have high potential for improving the quality of care in Ontario for people with acute pain who have been prescribed or are considering opioids.
Below is a sample of tools that may help you with the implementation of the quality statements into practice.
This list is not exhaustive. Are there other tools or resources you use? Do you have experience implementing these tools? If so, please use the comments section below to share!
1. Comprehensive Assessment: People with acute pain receive a comprehensive assessment to guide pain management.
This quality statement lists eight elements that should be included in a comprehensive assessment for patients with acute pain. The following tools may be helpful in conducting these comprehensive assessments:
2. Multimodal Therapies: People with acute pain receive multimodal therapy consisting of non-opioid pharmacotherapy with physical and/or psychological interventions, with opioids added only when appropriate.
This quality statement lists a set of multimodal therapies that could be offered to patients with acute pain. Health care professionals should work with the patient to create a multimodal pain management plan.
3. Opioid Dose and Duration: People with acute pain who are prescribed opioids receive the lowest effective dose of the least potent immediate-release opioid. A duration of 3 days or less is often sufficient. A duration of more than 7 days is rarely indicated.
- Essential Clinical Skills for Opioid Prescribers by Women’s College Hospital and the Institute for Safe Medication Practices provides recommendations on opioid prescribing, tapering, opioid agonist therapy and overdose prevention
- Key Opioid Prescribing Messages for Community Practitioners by the Institute for Safe Medication Practices summarizes key prescribing messages to support community prescribers
- The Opioid Manager by the National Pain Centre is a point-of-care tool to support health care professionals in prescribing and managing opioids; although the tool is designed for chronic pain, components may be relevant to patients with acute pain
- The Opioid Wisely campaign by Choosing Wisely Canada provides speciality-specific recommendations for when opioids should not be first-line therapy
4. Information on Benefits and Harms of Opioid Use and Shared Decision-Making: People with acute pain and their families and caregivers receive information about the potential benefits and harms of opioid therapy, safe storage, and safe disposal of unused medication at the times of both prescribing and dispensing.
5. Acute Pain in People Who Regularly Take Opioids: People with acute pain who regularly take opioids receive care from a health care professional or team with expertise in pain management. Any short-term increase in opioids to treat acute pain is accompanied by a plan to taper to the previous dose.
- The Ontario eConsult Program connects requesting health care professionals to specialists, enabling them to receive answers to clinical questions about their patients’ pain management quickly and securely
- Project ECHO’s Chronic Pain and Opioid Stewardship Sessions are weekly CME-accredited videoconferencing sessions that connect clinicians with an interprofessional pain specialist team
- The Medical Mentoring for Addictions and Pain Collaborative Mentoring Network by the Ontario College of Family Physicians connects family physicians with experts in pain and addictions to help manage patients’ pain, addictions and the challenges around opioid prescribing
6. Acute Pain in People With Opioid Use Disorder: People taking buprenorphine/naloxone or methadone for the treatment of opioid use disorder continue their medication during acute-pain events.
7. Prescription Monitoring Systems: Health care professionals who prescribe or dispense opioids have access to a real-time prescription monitoring system at the point of care. Prescription history is checked when opioids are prescribed and dispensed to avoid duplicate prescriptions, potentially harmful medication interactions, and diversion.
- The Digital Health Drug Repository by eHealth Ontario allows health care professionals to access patients’ clinically relevant drug and pharmacy service information to assist with medication reviews
8. Tapering and Discontinuation: People prescribed opioids for acute pain are aware of the potential for experiencing physical dependence and symptoms of withdrawal and have a plan for tapering and discontinuation.
- The Opioid Tapering Template by the Centre for Effective Practice can guide health care professionals to evaluate opioid therapies and reduce opioid dosages in safe and effective ways
- The Safer Opioid Prescribing Strategies course by Machealth teaches health care professionals strategies for when and how to taper and switch opioids
9. Health Care Professional Education: Health care professionals have the knowledge and skills to appropriately assess and treat acute pain using a multimodal approach; appropriately prescribe, monitor, taper, and discontinue opioids; and recognize and treat opioid use disorder.
Comment below to describe your experience with these tools or share any others you have found useful!
This post is part of a series about how quality standards can be used to support quality improvement together, and provides a forum for people who are working on adopting the quality standards to share ideas and experiences. The introductory post can be found here.