The All Wales Medicines Strategy Group has published the first guidance on analgesic stewardship in the UK.
The document — which has been adapted from the Quality Prescribing for Chronic Pain guide, published by the Scottish government and NHS Scotland in 2018 — is aimed to improve patient outcomes, reduce analgesic-related harm and ensure cost-effective use of analgesics to provide optimal pain management.
Among the recommendations to improve analgesic stewardship are that analgesic medicines should be initiated as a trial, regardless of indication, and that “functional goals” should be agreed between the patient and prescriber at initiation, with a fixed time period and review date agreed.
“An explanation of how analgesic medicines that are not assisting with attainment of functional goals will be reduced and stopped, should be given at initiation and again when medicines are reviewed,” the guidance states.
It also recommends that analgesics should not be given as repeat prescriptions unless clear evidence of benefit is demonstrated at a review and that prescribers should consider issuing no more than three months of repeat prescriptions each time, to encourage regular review.
A spokesperson for the All Wales Therapeutics and Toxicology Centre, which holds the guidance, said the resource was developed at the request of Welsh Government and aimed to support the prescribing of medicines used in NHS Wales for the management of pain.
“Analgesic stewardship aims to improve patient outcomes, reduce analgesic-related harm and ensure cost-effective use of analgesics. Analgesic stewardship activities may include guideline development, monitoring of analgesic use, and trends and provision of education material to patients and practitioners.
“We hope the guidance will support health boards to work with stakeholders from all sectors, including community pharmacy to develop strategies to improve analgesic stewardship within their local communities.”
Emma Davies, advanced pharmacist practitioner in pain management, Cwm Taf Morgannwg University Health Board and co-clinical lead for the guideline, said more analgesics were prescribed per capita in Wales, than in England, Scotland or Northern Ireland.
“So we know that it is a big problem,” she added.
“I believe this is the first national guideline in the UK that refers specifically to analgesic stewardship. For Wales, it is the first nationally developed guideline to support prescribers in the prudent use of analgesic medicines.”
Davies said that an “important feature” of the stewardship guidance was that it placed the onus on health boards in Wales to develop cross-sector pathways, strategies and policies to improve, not just the use of analgesic medicines, but also support services for people living with pain.
“It acknowledges that, without timely support, people may end up relying on medicines that are not helping them live better with pain and may actually contribute to worsening health and wellbeing,” she added.
“The document promotes pharmacists and medicines management teams, in monitoring prescribing but also providing education and training on safe prescribing, guideline development and, of course, as prescribers themselves.”
Roger Knaggs, a specialist pharmacist and president elect of the British Pain Society, said that, as the first document from any UK nation on analgesic stewardship, it was “clearly a step forward”.
“It is a comprehensive distillation of key nation guidance together with practical recommendations for practice and healthcare systems to adopt,” he added.
“Unfortunately, it does not address prescribing in specialist services, although they are expected to follow national and local guidance. But in order to take a systems approach all stakeholders must be included.
“Implementation will be key and crucial for success.”
Opioid prescribing in Wales increased by 30% in the ten-year period from 2008/2009 to 2018/2019, according to figures published by the Welsh government on 10 February 2020.