Collaborating for medicines safety

A programme to reduce the avoidable harm caused by opioids is now on a firm footing in the North West Coast.

Health Innovation North West Coast has worked with the integrated care systems in Cheshire and Merseyside and Lancashire and South Cumbria on the National Medicines Safety Improvement Programme (MedSIP), to support them in developing a ‘whole-system’ approach to the challenge of high-risk opioid prescribing for chronic non-cancer pain.

Opioids are very good pain relief for acute pain and for pain at the end of life when used with care. However, in the case of chronic non-cancer pain, when the source of long-term pain does not have a cause that can be treated, they can do more harm than good, particularly when used long term and at higher doses.

Around 6,000 people a year could be hospitalised because of taking opioids for extended periods if left unchecked. Prescribing rates for opioids are particularly high in the North West.

The Patient Safety Collaborative in Health Innovation North West Coast helped set up multi-agency partnerships across the region at place level.

It hosted a series of workshops aimed at convening teams, securing high-level support to agree on priorities and start to develop an action plan, ensuring stakeholders were fully engaged and able to help secure gains.

The diverse teams included pharmacists, practice managers, heads of commissioning, clinical directors, consultants, charity representatives, lived experience experts and others – individuals who might not otherwise have joined forces.

Teams have taken the learning from the workshops and started to turn this into action, including:

• Re-thinking stakeholder membership for local action groups – broadening this out and relaunching as a community of practice.
• Taking learning from others and exploring how to implement at a local level, for example establishing pain cafés, delivering patient awareness campaigns, and creating toolkits to target changes in prescribing. 
• Using the methodologies to develop these ideas using the ‘plan, do, study, act’ model to underpin the work.
• Thinking about the potential for unintended consequences and how to mitigate them.

Faye Prescott, Morecambe Bay place lead from NHS Lancashire and South Cumbria, said: “The team at Health Innovation North West Coast have been a great support to those individuals who participated in the workshops, providing us with improved insight and understanding of quality improvement tools that can be taken to our local communities of practice.

“The skills obtained will no doubt enhance the further work needed across providers and organisations, to continue to reduce harm from inappropriate opioid prescribing.”

Lucy Reid, Associate Director of Pharmacy – Integrated Clinical Services, Wirral University Teaching Hospital NHS Foundation Trust, working across NHS Cheshire and Merseyside, said: “Health Innovation NWC were able to bring fresh ideas and a lot of energy and a sense of purpose to the problem.

“Given the size of our ICS it has been an overwhelming task to try to tackle effectively across all areas. But the sessions helped us to think through a system lens, and by starting small and using learning from others it has given us a renewed motivation to approach this at ICS level rather than trying to tackle just within individual Places.”

Health Innovation NWC’s Coaching Academy facilitated the workshops and prepared teams for making changes in the way they and colleagues worked and for introducing and embedding improvement methods. The work aimed to equip teams with some of the tools, techniques and theories to support them in implementing the approach locally.

Data from primary care shows that since the beginning of the pandemic there has been a 27 per cent increase in the number of patients who are prescribed opioid analgesics for longer than three months, which is the limit recommended by the Faculty of Pain Medicine. This increases the risk of long-term dependence which is strongly associated with increased mortality.

It is estimated that for every 62 patients with chronic pain who can be supported with alternatives to long-term analgesia, one life can be saved. Unchecked, it is predicted that around 6,000 people a year will be hospitalised with adverse events while taking opioids for extended periods.

Health Innovation NWC will support the ICSs of Cheshire and Merseyside and Lancashire and South Cumbria to undertake a ‘rapid insights’ session to help inform next steps.