Ground-breaking project uses order sets for opioids

THUNDER BAY, Ont. – Opioid digital order sets were launched this month at Thunder Bay Regional Health Sciences Centre (TBRHSC). The groundbreaking pilot project aims to improve outcomes for patients who require post-operative pain management. The new opioid order set, developed by a working group including staff from TBRHSC supports addressing the opioid crisis.

“Healthcare providers will be able to use this digital checklist, or clinical order set, to guide decisions for their patient’s pain management. When pain and medication is managed properly, patients are able to recover more quickly and spend less time in the hospital,” said Dr. Gordon Porter (pictured), chief of staff at TBRHSC.

“Most importantly, the digital order sets can reduce the use of opioids because they provide very specific evidence-based recommendations and considerations for various post-op scenarios. These guide decisions for pain management so that there is either a reduced need to prescribe medication, pain medication can be weaker doses, and those medications may be required for shorter periods of time,” Porter explained.

Ontario is experiencing increasing numbers of opioid-related deaths and a growing prevalence of opioid addiction. The causes of the opioid epidemic are many, but the data demonstrates that higher prescribing rates for opioids are closely associated with higher opioid-related overdoses.

According to Health Quality Ontario, more people in Ontario are being prescribed stronger opioids. For example, the number of people who filled a prescription for hydromorphone – which is approximately five times stronger than morphine – increased by nearly 30% over three years.

The opioid digital order set provides standardized guidance for acute pain management for various post-op scenarios. Controlling and decreasing pain leads to better post-surgery outcomes, improved patient experiences, and reduced opioid prescribing rates.

Over the next three months, the Acute Pain Service (APS) Team at TBRHSC will pilot the use of the order set before a wider rollout to other areas across the hospital. Their feedback will also inform a larger provincial strategy.

The opioid order set was developed as part of the Provincial Digital Quality-Based Procedures (QBP) Program, an initiative funded by the Ministry of Health and Long-Term Care focused on accelerating the adoption of Ontario’s QBP Clinical Handbooks and Health Quality Ontario’s (HQO) Quality Standards.

As part of this innovative program, Ontario-based digital health leader, Think Research, has created digital order sets for 40 QPBs to ensure evidence-based care is provided in 80 acute care hospitals across Ontario.

To ensure depth of feedback on the clinical content, a collaboration was established between the QBP program, Think Research, HQO, the North West LHIN and 20 clinical leaders in the region from acute, primary, community and mental health. Experts from TBRHSC were among the group and the resulting order set addresses appropriate opioid prescribing, tapering and discontinuation for adults.