Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard

From the 2022 HVPA National Conference

Steve Waller Bachelor of Pharmacy; MBA (Australian Commission on Safety and Quality in Health Care)


Medication-related harm from opioid analgesics was identified in Australia’s response to the World Health Organization Global Patient Safety Challenge – Medication without harm (2020). The Australian Commission on Safety and Quality in Health Care (the Commission) developed a national opioid analgesic stewardship clinical care standard (the Standard).


The Standard aims to minimise the risk of harm associated with opioid analgesic use. The Standard seeks to ensure the appropriate use and review of opioid analgesics for the management of acute pain, to optimise patient outcomes and reduce the potential for opioid-related harm.


The development of the Standard was informed by public consultation. Nine quality statements were produced to shape the final version of this clinical care standard, which are:
– Patient information and shared decision making
– Acute pain assessment
– Risk-benefit analysis
– Pathways of care
– Appropriate opioid analgesic prescribing
– Monitoring and management of opioid analgesic adverse effects
– Documentation
– Review of therapy
– Transfer of care

An indicator set has been developed to support clinicians and health services organisations to monitor implementation of the Standard. The indicators are intended to support local quality improvement activities.


The Standard’s scope applies to care provided in emergency services, including ambulance services. It also applies to all hospital settings, including public and private hospitals, subacute facilities, and outpatient and day procedure services.

It is expected that the systematic approach to optimising the use of opioid analgesics, as outlined by the Standard, will allow for the appropriate and safe use of opioid analgesics, with effective monitoring and surveillance.

Opioid analgesic stewardship programs ensure appropriate dosing and duration of opioid analgesics, as well as a reduction in inappropriate opioid analgesic use and incidents of opioid related harm. This Standard seeks to reduce the potential for the occurrence of opioid-related harm by limiting the use of modified-release opioid analgesics for acute pain, so that they are used only in exceptional circumstances and not routinely.

Effective implementation of the Standard will also reduce healthcare and economic costs associated with inappropriate opioid analgesic use.


This Standard is instrumental to the care of people of all ages with acute pain for whom opioid analgesics may be considered or prescribed.

The Standard addresses the key components of patient care, reflected in the nine quality statements. These statements support patients regarding what care may be offered and support informed treatment decisions.

Through the quality statements, health service organisations are supported in understanding the policies, procedures and organisational factors that can enable the delivery of high-quality care.

Clinical Implications

When applying the information contained in the Standard, clinicians are advised to use their clinical judgement and to consider the individual patient’s circumstances, in consultation with the patient, or their support people.

This Standard aligns with key principles that are the foundation for achieving safe, high quality care including person-centred care and shared decision making, informed consent, and cultural safety for Aboriginal and Torres Strait Islander people.

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