Developing a unit dose approach to managing oral opioid liquids in an Australian hospital

Background

Liquid opioids (controlled drugs) in multidose bottles (MDBs) are associated with measurement losses, overfill variance, gradual contamination, and potential theft. Western Australian state poisons regulations and policies require rigorous accountability and previous reports have highlighted shortcomings in historical arrangements.

Aim

To describe the process and outcomes of a transition to unit dose pod (UDP) formulations for oral liquid opioids at our institution.

Method

A UDP of oral oxycodone liquid was developed in partnership with a third-party compounder and piloted on a paediatric ward. Additional UDP opioid formulations were developed and gradually replaced MDBs across our institution. Reportable discrepancies and staff satisfaction were compared between MDBs and UDPs. This project was registered as a quality improvement project (GEKO 27758) and considered exempt from human research and ethics approval by the South Metropolitan Health Service Human Research Ethics Committee.

Results

Between May 2017 and May 2018, 3062 UDPs were distributed with nil discrepancies, and 133 MDBs were distributed with 16 discrepancies (0% vs 12%). Most staff (92%) reported more efficient inventory counts and improved confidence in product integrity for UDPs. Staff administrative overhead required to manage reportable discrepancies from volume errors was essentially eliminated. Five UDP opioid formulations were implemented in 27 inpatient wards including methadone-maintenance UDPs for inpatient use. By late 2020, UDPs were in use across 19 hospitals in Western Australia (WA), with annual use exceeding 33 000 units.

Conclusion

The UDP simplifies the management of controlled drug liquids by eliminating discrepancies associated with MDBs inventory management and increasing staff confidence in product quality, leading to significant uptake across WA.