Cultivating optimal analgesic prescribing practices in a metropolitan hospital network: evaluating an analgesic stewardship program

Background

The increasing incidence of opioid-related harm associated with inappropriate opioid prescription underscores the need for effective interventions directed at enhancing analgesic prescribing practices. Analgesic stewardship (AGS) programs have emerged to facilitate appropriate analgesic use, reducing analgesic-related harm and optimising patient outcomes.

Aim

This study aimed to assess the impact of an AGS program on the appropriateness of opioid analgesia prescribing for adult inpatients within a metropolitan health network during the initial two months following program implementation.

Method

This retrospective audit examined de-identified aggregate data of 100 adult inpatients of a major Australian metropolitan hospital network between August–September 2022. The multidisciplinary AGS program involving pharmacy, nursing, and medical staff provided clinical interventions and recommendations for patients, supported by organisational interventions, including education and guideline reinforcement. Data collection included patient demographics, clinical data, and AGS program recommendations documented in patient medical records. Ethical approval was granted by the Eastern Health Office of Research and Ethics (Reference no: QA23-015-91886) and the study confirms to the Australian Statement on Ethical Conduct in Human Research.

Results

It was found that 51% of opioid-naïve patients were prescribed modified-release opioids for acute non-cancer pain, contrary to local guidelines. The AGS program recommendations resulted in an 89.7% cessation of these prescriptions. For non-opioid-naïve patients, there was a statistically significant reduction in mean Oral Morphine Equivalent Daily Dose of 19.85 mg (95% confidence interval [CI] 10.3–29.4 mg, p < 0.05). AGS recommendations were predominantly adhered to, with 82% showing full or partial compliance.

Conclusion

This study highlights the positive impact of an AGS program on the appropriateness of opioid analgesic prescribing for adult inpatients. These findings support the implementation of AGS programs into healthcare systems to mitigate opioid-related harm and improve patient outcomes.