Development of a continuous subcutaneous infusion order and administration chart for opioids and other medications used in palliative care based on medication safety principles

The Safe Medication Practice Unit was established in 2005 continuing work that had been undertaken in developing a number of principles and products enhancirig a safety-based approach to all aspects of medication practice (i.e., prescribing, dispensing, administration and communication). These products included development of a Queensland Health statewide standard medication chart that has since been chosen as the template for a National Implementation of Medication Chart Project established in all states under the auspices of the then Australian Council for Safety and Quality in Health Care.

The principles used were enshrined in the Medication Safety Collaborative model used by the Council:

 • Collaboration
 • Use of the PDSA (Plan, Do, Study, Act) cycle
 • Basing changes upon iterative observation and study of existing processes
   and process failures
 • Appropriate use of human error engineering principles of forcing function,
   standardisation, policy development and education

Opiates have long been recognised as medications with High Risk potential for harm. Opioid use is a common therapeutic approach in palliative care and in the use of continuous subcutaneous infusions (csci) of opioids and other medications, including sedative agents, is a common feature of palliative care within Queensland's health care facilities.

A variety of iterations in form design were created, discussed and user tested with key stakeholders from Palliative Care physician, nursing and pharmacy focus groups and clinical teams, changes made and observational audits followed the trial of these documents and this process continues using the PDSA cycle. The latest iteration will be presented together with the outcomesfrom its current trial process.

A mini HEAPS (Human Error and Patient Safety) examination of a large number of clinical incidents involving the administration of opioids and sedatives by continuous sub-cutaneous infusion revealed a number of failure points in currently used prescribing, administration and documentation methods including failures in prescribing, prescribing review, formulation and calculation, administration and patient observation associated with inexperience and conflicting demand on experienced staff.

The current form was designed to address these issues.