Midland Quality Steering Group improvement advisors Charlotte Foley (Lakes District Health Board) and Ros Morell (Waikato District Health Board) are local project leads for the Health Quality & Safety Commission’s national collaborative on the safe use of opioids in hospitals. The aim of the collaborative is to reduce harm from opioids by 25 percent by June 2016.
Each DHB has a working group to drive the project locally and to focus on specific areas of opioid use that cause patient harm in their organisation. A two-day national learning session at the end of February was the first real chance for hospital teams to meet and discuss their own aims and strategies. All DHBs were represented and it was a valuable opportunity to define and refine work streams, to make them achievable and sustainable in the long term.
A large number of hospitals, including Lakes’ and Waikato, are focusing on the most common type of harm, which is constipation. Other subjects include management of discharge prescriptions, management of nausea and vomiting, and the use of fentanyl patches.
The project is being run using Institute for Healthcare Improvement methodology, which is underpinned by the Model for Improvement and the System of Profound Knowledge. As a tried and tested methodology in health care, and supported by a number of improvement advisors nationally, this approach enables a structured, logical, manageable and measurable approach to change.
The learning session provided the opportunity to use the different tools that support the project and for staff not previously exposed to this methodology to have first-hand experience in how and why it works. For example, an important part of the methodology is to carry out small tests of change rather than deciding on a change and going straight to large ‘pilots’ and implementation. The value of multiple small tests under different conditions lies in the ability to identify weaknesses of our proposed intervention while minimising risk, cost and staff confusion. As our degree of belief increases that this intervention will be successful, we can increase the size of the tests until we are ready to implement. Of course, part of the methodology is around recognising and learning from failed tests, which sometimes require us to revert to smaller tests.
Keeping project aims achievable is a significant challenge and all teams had to work hard to define clear aims and the different change ideas that could be tested to achieve the aim. With Waikato and Lakes working on the same harm, the opportunity to share ideas, audit tools, information and measures is of great value. Close collaboration across the whole programme and willingness to share ideas supports ongoing improvement in multiple areas.