Opioids provide acute analgesia however prolonged use increases the risk of dependence and harm. A local audit identified that 50% of patients newly started on opioids were discharged without a documented review plan, and they continued to receive opioids in the community 4 weeks later. These patients were admitted to community health service wards for rehabilitation following a fall, stroke or surgery. Additionally the patient cohort reflected were elderly and often frail, increasing their vulnerability to opioid related adverse effects. This finding highlighted the need for a robust and reliable stewardship process to support safe opioid use aligned with national guidance.
To address these concerns, a system wide coordinated quality improvement approach was adopted. This included process mapping, stakeholder engagement, baseline data review, and driver diagrams, leading to a three month pilot of a weekly pharmacist prescriber led ward round focused on reviewing newly initiated opioids. Interventions involved structured pain assessments, collaboration with physiotherapists to consider rehabilitation potential, review of opioid indication and duration, optimisation of related non opioid medications, deprescribing and withdrawal planning, enhanced documentation, and multidisciplinary team (MDT) engagement. Outcomes measured included review rates, number of opioid and non opioid interventions, and consultation time.
Following implementation, the proportion of patients reviewed increased, with an average of 68% assessed. Consultations averaged 30 minutes, with three opioid related and four non opioid pharmacological interventions per round. MDT feedback indicated improved confidence and clarity in opioid management, demonstrating the value of of structured stewardship in reducing opioid related harm.

• Impact and risks of short term pain.
• Insight into local project responding to local concerns.
• Impact of a pharmacist led pain review