Quality standard

Quality statement 3: Strong opioids and monitoring

Quality statement 3: Strong opioids and monitoring

Quality statement

People with an acute painful sickle cell episode who are taking strong opioids are monitored for adverse events every hour for the first 6 hours after first administration or step up of pain relief and then at least every 4 hours.

Rationale

Monitoring for adverse events in people with an acute painful sickle cell episode who are taking strong opioids is important to ensure patient safety. Monitoring is initially done hourly because the risk of adverse events is higher in the first 6 hours after first administration or a step up of pain relief.

Quality measures

Structure

Evidence of local arrangements to ensure that people with an acute painful sickle cell episode who are taking strong opioids have monitoring for adverse events every hour for the first 6 hours after first administration or step up of pain relief and then at least every 4 hours.

Data source: Local data collection.

Process

a) Proportion of people with an acute painful sickle cell episode taking strong opioids who are monitored for adverse events every hour for the first 6 hours after first administration or step up of pain relief.

Numerator – the number of people in the denominator who are monitored for adverse events every hour for the first 6 hours after first administration or step up of pain relief.

Denominator – the number of people with an acute painful sickle cell episode taking strong opioids.

Data source: Local data collection.

b) Proportion of people with an acute painful sickle cell episode taking strong opioids who have had hourly monitoring for adverse events for the first 6 hours after first administration or step up of pain relief and who are then monitored for adverse events at least every 4 hours until discharge or the end of the episode.

Numerator – the number of people in the denominator who are monitored for adverse events at least every hour 4 hours until discharge or the end of the episode.

Denominator – the number of people with an acute painful sickle cell episode taking strong opioids who have had hourly monitoring for adverse events for 6 hours following first administration or step up of pain relief.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that they have sufficient resources for people with an acute painful sickle cell episode who are taking strong opioids to be monitored for adverse events every hour for the first 6 hours after first administration or step up of pain relief and then at least every 4 hours until discharge or the end of the episode.

Healthcare professionals ensure that people with an acute painful sickle cell episode who are taking strong opioids are monitored for adverse events every hour for the first 6 hours after first administration or step up of pain relief and then at least every 4 hours until discharge or the end of the episode.

Commissioners ensure that they commission services that provide sufficient resources for people with an acute painful sickle cell episode who are taking strong opioids to be monitored for adverse events every hour for the first 6 hours after first administration or step up of pain relief and then at least every 4 hours until discharge or the end of the episode.

People with a painful attack of sickle cell disease (acute painful sickle cell episode) who are taking strong painkillers (strong opioids) are checked for possible side effects every hour for the first 6 hours and then at least every 4 hours until they leave hospital or their episode has ended.

Definitions of terms used in this quality statement

Strong opioids

Strong opioids are drugs that have a similar action to morphine. They are mainly used for pain relief. Examples include morphine, diamorphine, fentanyl, oxycodone and buprenorphine. [NICE's full guideline on palliative care for adults: strong opioids for pain relief]

Monitoring for adverse events

Monitoring for adverse events is defined as a clinical assessment that includes a sedation score. [NICE's guideline on sickle cell disease, recommendations 1.1.5 and 1.1.16]

A clinical assessment should also assess:

  • blood pressure

  • oxygen saturation

  • pulse rate

  • respiratory rate

  • temperature.

Be aware that some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin. See also the NHS England Patient Safety Alert on the risk of harm from inappropriate placement of pulse oximeter probes.

Step up of pain relief

A step up of pain relief is either moving from a milder painkiller such as non-steroidal anti-inflammatory drugs/paracetamol to mild opioids and then to stronger opioids or an increase in dosage of analgesia. [Adapted from Analgesic Ladder, World Health Organization (1986) and expert opinion]

Timing of monitoring

Monitoring for adverse events should be done every hour for the first 6 hours and then at least every 4 hours, until either discharge or end of the acute painful sickle cell episode. Certain groups, for example, children and people on patient-controlled analgesia, may need to be monitored more frequently according to local protocols. [Adapted from NICE's guideline on sickle cell disease and expert opinion]