Opioid delivery comprises a large part of a palliative care nurses’ workload each shift in specialist inpatient palliative care services. The opioid delivery process is complex and time consuming, with mandated double checking and strict documentation requirements for each opioid administration, which has implications for management of staffing levels. However, the volume of opioid use in specialist palliative care services has not been previously quantified.
To quantify the number of opioids ordered and administered in three specialist palliative care inpatient services over a seven-day period.
A retrospective snapshot audit of opioid orders and administrations.
The seven-day snapshot audit captured opioid orders and administrations for 120 palliative inpatients in three specialist palliative care inpatient services in metropolitan NSW. Patients spent an average of 5.4 days (±2.4) in the palliative care unit in the audit period. Almost all (98%) palliative inpatients had at least one opioid order (regular, PRN or STAT). One-third of patients (29%) had two or more regular opioid orders, and almost half (44%) had two or more PRN orders. In total, there were 10,031 opioid doses ordered and 1,732 opioid doses administered across participating services in the audit period, equating to 12 opioid orders per patient, per day. Opioids were administered 247 time per day, equating to one opioid administration approximately every six minutes in the specialist palliative care inpatient service.
Implications for practice
For palliative care nurses, managing interruptions and competing demands is an inevitable but routine part of opioid preparation and delivery, determined by: the fluctuating needs of the patient population; the additional time burden of opioid preparation compared to other, less high-risk medicines; and increased workload due to issues with nursing staffing and/or skill mix ratios. Quantifying the time burden of opioid delivery in the palliative care inpatient context may help inform management of staffing levels, as time spent on medication administration is frequently underestimated.
Acknowledging that palliative care nurses spend a substantial amount of time engaged in opioid preparation, and are simultaneously managing multiple competing demands when handling high-risk opioids, is an essential medication safety consideration and a workforce issue.