Quality statement 8 - Review of therapy

If you are prescribed an opioid analgesic while in hospital, your clinicians should regularly check that you still need the medicine, that the medicine is helping your pain and that it is the best medicine for you. Your pain and ability to function will be regularly checked, and the amount of opioid analgesic you take will be reduced as your condition improves and your need for pain relief decreases.

If your pain does not improve when you take an opioid analgesic your clinician may change your medicine or refer you to other hospital-based support services. These may include specialist services for children and adolescents, pain management, drug and alcohol, clinical pharmacy, and allied health such as physiotherapy.

When opioid analgesics are prescribed, the effectiveness, appropriateness and ongoing need for opioid analgesic therapy should be regularly reviewed according to the patient’s stage of care. If the opioid analgesic is continued, decisions about the appropriate daily dose of opioid analgesic should be based on the oral morphine-equivalent daily dose (oMEDD) given in the past 24 hours.

During their hospital care, a patient prescribed an opioid analgesic for acute pain should have regular assessment of their pain and function. Due to interpatient variability, the timing of regular assessments should be tailored to the needs of the patient considering the patient’s sedation scores, physical state, ability to move and engagement with active interventions such as physiotherapy.

Consider alternative pain management for patients whose acute pain does not respond to opioid analgesics. This may include changing the opioid analgesic to a non-opioid medicine, nonpharmacological management or referral to other hospital-based support services. These may include specialist services for paediatrics, pain management, drug and alcohol services, clinical pharmacy, or allied health.

If opioid analgesics are being administered intravenously, consider switching to oral opioid analgesic options as soon as the oral route is available.

Ensure review of opioid analgesic treatment occurs immediately before the patient leaves the hospital. The aim of opioid analgesic therapy should be to manage the patient’s acute pain with an opioid analgesic for the shortest duration possible.

Ensure systems are in place for clinicians to regularly review the effectiveness, appropriateness and ongoing need for opioid analgesics according to the patient’s stage of care. In hospital, this includes ceasing opioid analgesics when no longer necessary and reviewing regularly from the first prescription. Ensure an oMEDD calculator is available for clinicians to determine the appropriate daily dose of opioid analgesic.

Include systems to ensure that review of opioid analgesics occurs immediately before the patient leaves the hospital.

Ensure referral and escalation of care processes are in place to support clinicians when a patient’s acute pain does not respond to opioid analgesic therapy. This may include referral to other hospital-based support services, including escalation to specialist services for paediatrics, pain management, drug and alcohol, clinical pharmacy and allied health.

Ensure policy, procedures and systems are in place to support clinicians to change from intravenous to oral opioid analgesics in patients with acute pain. This should include incorporating flags in electronic medication management systems where these are in use.