Measuring Safer Opioid Use in Hospitals: Development of Consensus-Based Safety and Quality Indicators - a modified Delphi study

BACKGROUND: A significant contributor to preventable medication related harm is opioids. Within Australian hospitals, opioids have contributed to deaths, hospital admissions, and in-hospital related harm. Given these harms, there is a need to ensure opioids are used safely and that systems which support safe opioid use are in place and are effective. These should be monitored and when required, actions should be taken where a need for performance improvement is identified, or system change is warranted. Hence, the aim of this study was to develop a consensus-based suite of opioid-related safety and quality indicators (SQIs) that are evidence-informed, important and feasible for routine monitoring across an entire health service. METHODS: A structured search of the academic and grey literature was undertaken to identify relevant SQIs. A 22-member hospital based multidisciplinary clinical reference group (CRG) participated in a modified Delphi multi-round electronic survey. Participants rated importance and feasibility of each SQI on a 9-point Likert scale. Between survey rounds, participants were provided with an individualised report and a virtual meeting was held to enable group discussion on views relating to non-consensus indicators. Consensus was set as a median score rated as high (i.e. >6.5) and lower interquartile range not less than 5. RESULTS: In total, 121 articles were identified from the academic literature, seven within the grey literature and two procedures. After abstract and full text review, nine articles/documents containing relevant SQIs were identified. There were 30 SQIs extracted and after rationalisation, 23 SQIs were presented to participants. Survey round 1 participants proposed 11 additional indicators, resulting in a total of 34 indicators being considered by the CRG. There were 22 clinicians who expressed an interest in participating in the survey rounds and CRG meeting. Response rate for round 1 was 91% (n = 20), CRG meeting was 50% (n = 11) and survey round 2 was 77% (n = 17). In total, 17 indicators reached consensus for importance and feasibility. CONCLUSION: Consensus has been reached on 17 opioid-related safety and quality indicators which have been deemed important and feasible by a multidisciplinary CRG. Implementing these into practice will assist with monitoring and reporting of the effectiveness of opioid medication safety systems and identify improvement opportunities, ultimately enhancing patient safety.