Safe Use of Opioids Collaborative


Effective pain control is important for recovery from injury, surgery and illness. Opioids, such as morphine and oxycodone, are particularly effective for managing pain after procedures and surgeries but they are not without risk. Safe opioid use is needed to ensure side effects are minimised and pain effectively managed.

Led by the Health Quality and Safety Commission (HQSC), the National Safe Use of Opioids Collaborative was launched to reduce opioid related harms such as constipation, nausea and vomiting (N&V) and uncontrolled pain, all of which which can delay recovery and increase the risk for further complications.  

Clear guidance on how to monitor and manage pain for both clinicians and our patients

Better pain management practices

Improve pain management at Waitemata DHB by providing:

  • clear guidance on how to monitor and manage pain for both clinicians and our patients
  • better pain management practices such as:
    1. more regular assessment and documentation of pain
    2. better monitoring of life threatening side effects of opioids (especially after the use of patient controlled analgesia (PCA))
    3. more routine administration of regularly prescribed pain relief medicines
    4. more timely offering of analgesia to patients with pain

This project was a collaborative effort between the Institute for Innovation and Improvement (i3), Acute Pain Management Team, Pharmacy, Ward 4 and 7 and Consumers.

We examined current practices and spoke with our patients and found there was a need to improve pain management at Waitemata DHB. Specifically, we identified the need for clear guidance on monitoring and managing pain for both clinicians and our patients and better pain management practices.

To provide clear guidance on how to monitor and manage pain, we:

  • developed a comprehensive pain management resource for clinicians that provides clear guidance on how to appropriately manage pain

  • co-designed with our consumers and staff a "Speak Up" Patient Information Leaflet and process which encourages conversations about pain and opioid side effects

  • trialled the patient information leaflet on iPads for patients on our wards (e.g. iPad photos with engagement utility)

safe use of opioids 

To improve pain management practices, we:

  • started a new programme with junior doctors being scheduled to attend the acute pain ward round so they can learn how to better manage pain from Senior Anaesthetists and Clinical Nurse Specialists 

  • promoted the development of pain management guidance resources at nursing leadership forums for dissemination to ward staff

  • undertook nursing Pain Study Days and questionnaires to further increase knowledge about how to better manage pain

  • had clinical nurse champions on the ward to lead and educate other ward staff to improve pain management

  • provided regular updates and feedback on ward audits to keep staff up to date with the progress of the project

  • aligned pain management standards with Patient and Whānau Care Standards

Post implementation, patients are more likely to: have their pain routinely monitored (increasing from 36% pre to 80% post implementation); be administered their regularly prescribed analgesia (increasing from 15% pre to 50% post) and be offered additional analgesia when in pain (increasing from 36% pre to 80% post).

Despite significant improvements to acute pain management practices, no demonstrable change to uncontrolled pain rates was observed.

We intend to continuing working with our consumers and clinicians to improve pain management practices to enable safer opioid use and we have several initiatives currently underway. 

Ward audits on pain management from Feb 2015 to Mar 2016 (n=117 patients) showed:

  1. The routine monitoring of pain has improved from 13% to 46%

    Routine monitoring of pain 

  2. The monitoring of life threatening side effects when Pain Controlled Analgesia (PCA) was used has improved from 4% to 56%

    Monitoring life threatening side effects 

  3. The routine administration of regularly prescribed pain relief medicines has improved from 18% to 54%
    Routine administration regularly prescribed pain relief

  4. The routine offering of additional pain relief medicines when the patient is in pain has improved from 42% to 80%
    Routine offering additional pain refief medicines

Despite improvements in the monitoring and management of pain and encouraging staff to have meaningful conversations with patients about their pain and side effects:

  1. the overall rate of uncontrolled pain remains relatively unchanged from 10% to 16% (not statistically significant)

    p chart uncontrolled pain 

  2. the overall experience of pain management remain relatively unchangedPatient experience of pain management ward 4 scores
  1. Implementing the "Speak Up" patient information leaflet on other wards, with some encouraging positive results already being shown

  2. Trialling, for the first time in New Zealand, the inclusion of the "Speak Up" patient information leaflet as an educational resource for patients in our Patient Engagement System on a surgical ward

  3. Continuing to refine and implement our pain management educational resources and process

  4. Incorporating standardised Pain Management Guidelines into nursing educational curriculum and ward accreditation standards

  5. Incorporating the lessons learnt and resources developed from the Safe Use of Opioid project to inform:

    1. our electronic vital signs monitoring (e-Vitals) project (eg when to alert clinicians when patients in pain, electronic prompts and clinical decision support to help clinicians make appropriate treatment choices)

    2. our electronic prescribing and administration (ePA) project (eg development of pain management pre-set orders for faster prescribing, co-prescribing of medicines which can be used to manage opioid side effects)

People involved

Jerome Ng1, Claire McGuinniety2, Wynn Pevreal2, Avril Lee2, Jessica Nand2, Christine Sherwood3, Glenn Mulholland3, Michal Kluger3, Laura Kerrisk4, Sarah Richardson4, Susan Johnston4, Ros Bell5, Ravenesh Kumar5, Aisha Mosqueda5, Judith Lunny6, Penny Andrew1

Departments involved

1i3, 2Pharmacy, 3Acute Pain Team, 4Ward 4, 5Ward 7, 6Consumer

Acknowledgements of the following people for their advice and support

Kate Gilmour, Jocelyn Peach, Kim Edmeades, Richard Harman, Michael Rodgers, Angela Lambie, Marilyn Crawley, Amanda McGowan, Prem Kumar, David Price, Jarrad O’Brien, Ineke Meredith, Kelly Fraher, Lara Hopley, Peter Groom, Peter Shapkov


Dr Jerome Ng

Lead Advisor Improvement Research + Informatics

Dr Penny Andrew

Director of i3