Quality statement 1 - Patient information and shared decision making

Acute pain is pain that lasts for a few moments, days or weeks. If you have acute pain, your clinician will explain your treatment options. These may include medicines and other treatments. The aim of these medicines and other treatments is to reduce your pain levels to allow you to undertake your regular day-to-day activities. They may not take away all your pain.

Your clinician will explain the possible benefits and harms (the good and bad things that might happen) of the different options. This can help you and your clinician decide how to manage your pain.

Opioid analgesic medicines (pain relief medicines commonly known as opioids) are one option, but they can have serious adverse effects. Your clinician may suggest trying other options first. Other options include non-opioid medicines, and other treatments such as heat packs, ice packs, exercise or physiotherapy. You and your clinician might decide that a combination of two or more treatments is best for you.

If you decide on a medicine, your clinician will give you instructions about what you need to do, especially if you will use the medicine after leaving hospital. It is important that you follow these instructions correctly to get the most benefit.

Talk to your clinician if you are not sure what to do, or if you have questions about:

• How many times a day to take the medicine and if the medicine should be taken with food
• Whether the medicine will affect other medicines you use
• What the adverse effects are and how to manage them.

If you are prescribed an opioid, only use the medicine for the reason it is prescribed, and do not give this medicine to other people, such as friends and family. Opioid analgesic medicines can make you sleepy. If you are prescribed an opioid analgesic do not drink alcohol or drive. Check with your clinician about what other medicines you can safely take, including sleep medicines, so you don’t have any negative interactions with the opioid medicine.

Discuss the patient’s expected recovery, and the potential benefits and harms of acute pain treatment options, with them or their carer. Tailor the options to the patient’s acute pain in line with a stepwise approach when providing treatment options, which may or may not result in prescribing opioid analgesics. This discussion should consider the patient’s preferences and needs, and any cultural and linguistic matters.

Inform the patient of suitable treatment options to help with symptoms, including paracetamol and non-steroidal anti-inflammatories, and nonpharmacological treatments such as splinting, heat packs, ice packs, physiotherapy and exercise.

If opioid analgesics are considered appropriate, discuss with the patient the importance of using opioid analgesics as prescribed, how to take them and for how long, potential opioid analgesic adverse effects and interactions with existing medicines, and when the treatment will be reviewed.

If opioid analgesics are supplied or prescribed on discharge, discuss how to safely store opioid analgesics and dispose of unused opioid analgesics by returning to the patient’s local community pharmacy.

Provide culturally and linguistically appropriate written information and resources to the patient about their treatment options and their analgesic treatment. When a patient is unable to receive information or participate in treatment decisions, provide information to the patient’s family or carer and offer them the opportunity to participate in decisions, if appropriate.

Document in the patient’s healthcare record what information was conveyed to the patient, including the provision of written information such as a consumer medicines information sheet, the Pharmaceutical Society of Australia’s Opioid Medicines fact sheet, information about safe storage and disposal, and the outcome of the shared decision making process. Outcomes of shared decision making should be documented wherever possible, including in the medication management plan and clinical handover summary.

Ensure systems are in place for clinicians to provide patients, and their family or carers, with culturally appropriate information and advice on acute pain treatment options.

Provide high-quality written patient materials and resources for use by clinicians and patients that have been developed in partnership with consumers, and meet the diverse needs of people who access your services.

Ensure processes are in place so that information is communicated to the patient about their treatment options and medication management or pain management plan, including at transitions of care (such as on transfer in, or discharge from, hospital).

Where opioid analgesics are prescribed, ensure systems are in place so that clinicians discuss with patients and their family or carers the need to take the medicine as prescribed, the expected duration of treatment, any potential adverse effects and interactions with existing medicines, and when their treatment requires review. Ensure systems are in place so that, on discharge, clinicians discuss with patients and their family or carers the possibility of harm if they give opioid analgesics to other people, and the safe storage and disposal of opioid analgesics.

Monitor patient understanding of information provided for acute pain treatment and evidence of shared decision making – for example, through patient surveys, patient-reported experience measures and patient-reported outcome measures.

• Clinical Excellence Commission NSW. Managing Side Effects of Opioid Medicines in Hospital: Information for patients, families and carers
• Choosing Wisely. Patient Guide to Managing Pain and Opioid Medicines
• SA Health. Oxycodone for Short-Term Management of Acute Pain
• SA Health. Information for Paediatric Patients, and Their Carer, Given Opioids for Short-Term Treatment of Acute Pain
• SA Health. Going Home After Having Been Given a Medicine That Can Make You Sleepy
• WA Health. Pain Relief Medications Following Surgery and Injury: Information for patients preparing for discharge
• TGA. Return Your Unused Opioids – Resource Kit
• Return Unwanted Medicines
• Pharmaceutical Society of Australia. Opioid Medicines Fact Sheet for Patients, Families and Carers