Authors: (including presenting author): :
Wong MC (1), Ng HY (1), Law KL(2), Ko PS(3), Chan PC(2), Li CY(3), Lam PT (3)
Affiliation: :
(1) Nursing Services Division, United Christian Hospital, (2) Kowloon East Cluster Pain Management Centre, Department of Anaesthesiology, Pain Medicine & Operating Services, United Christian Hospital, (3) Palliative Care Unit, Department of Medicine and Geriatrics, United Christian Hospital
Keyword 1: :
Strong opioid
Keyword 2: :
Quality & safety
Keyword 3: :
General wards
Introduction: :
Opioid toxicity is a potentially lethal complication, particularly in opioid-naive patients with strong opioid prescriptions for cancer or non-cancer conditions. In general ward, there are no clinical guidelines and systematic monitoring mechanisms to address the importance of early detection and intervention of opioid toxicity. This situation may pose a significant patient safety risk.
Objectives: :
To develop, implement, and evaluate a standardized opioid toxicity monitoring guideline and assessment chart for all general ward patients prescribed regular strong opioids.
Methodology: :
The quality improvement project using the Plan-Do-Check-Act (PDCA), in collaboration with Palliative Care and Pain Management Team. The project addressed an initial absence of formal structured monitoring protocols. In the Plan phase, needs identification was conducted and showed the necessity for structured staff education on risk factors and early signs of opioid toxicity, and the regular patient assessment. In the Do phase, a comprehensive guideline and structured monitoring chart were developed to standardize monitoring parameters and intervention thresholds. Hospital-wide training for nurses across 23 wards in five departments was conducted between 2021 and 2022. The Check phase includes a knowledge test administered before and 1-year post- guideline implementation between 2020 and 2023, and a compliance audit from Aug to Dec 2025. The Act phase will use audit findings to guide remedial training.
Result & Outcome: :
The guidelines and monitoring chart were successfully implemented. Over 200 general ward nurses completed the training, with a lecture video recording made available online for ongoing reference. 323 and 190 nurses completed the knowledge test before and 1-year post-guideline implementation respectively, with a 13.8% improvement in knowledge scores. 44 medical records from 22 general wards were randomly selected for review. Strong opioids were commonly prescribed for cancer pain, substance use disorder, and dyspnea conditions in pneumonia or COPD. The commonly prescribed strong opioids were morphine sulphate and methadone. No naloxone was prescribed during the audit period. The compliance rate of using the monitoring chart was 70%. Conclusion: Hospital-wide implementation of a structured opioid toxicity monitoring system is feasible and was successfully initiated. The 70% compliance showed a baseline level of adoption and highlighted the need for improvement. Targeted remedial actions are planned to enhance compliance and further encourage this critical safety practice.
