Is Opioid Patch Commencement in Aged Care Safe?

Is Opioid Patch Commencement in Aged Care Safe?

The title caught my attention!  Safety of opioid patch initiation in Australian residential aged care. I thought hmm- should be straight forward or is it, so I read the article which is enclosed for your information. The article shares the key findings of a 5 year Australian Study that included over 60 aged care facilities and aimed to   explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. 

The study findings were interesting and does make you consider if you work or have worked in aged care are there opportunities to improve related chronic pain management practices? Transdermal opioid patches have been designed to provide long-lasting therapy for patients with chronic pain. Two opioids are available for administration via transdermal patches: fentanyl and buprenorphine.  Do you know if they are being administered according to Best Practice

Do you know the current Australian guidelines recommend for chronic – non cancer pain a step wise approach.   The article identifies the process should be ‘An initial trial of non opioid analgesics followed by weak opioids if simple analgesics are not effective. Oral morphine or oxycodone and transdermal buprenorphine are considered first-line options for chronic non-cancer pain. For frail or older patients, a low dose of immediate-release opioid may be used to assess responsiveness; once initial dosing requirements have been determined, sustained-release preparations, including transdermal buprenorphine patches, may increase patient compliance…’

‘The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid naïve in the 4 weeks before initiation’

 The authors identified that ‘fentanyl patches were initiated in 2.6% of aged care residents, and buprenorphine patches in 8.7%. While the use of transdermal buprenorphine is recommended for the management of chronic pain, when commencing opioids in older patients a low-dose immediate release preparation is recommended once their opioid requirements have been ascertained, and the dose should be titrated accordingly.  It is also identified that Transdermal fentanyl is not recommended in opioid-naive individuals because of its high potency.’

The article also identified that despite residents being on these patches a number still required additional analgesia to manage their pain. This  paper highlighted for me the importance of assessing our patients and having an awareness of what the guidelines  are for drugs that we administer and where appropriate having dialogue  with Medical Officers as part of a collaborative health care  delivery team!

The Nurses for Nurses Network has a great range of continuing professional development  activities. The sessions are focused on Nurses who need to know about contemporary Nursing  in the ‘real world’ where Nurses are often time poor and resource limited!

Safety of Opioid Patches

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