Re-hospitalisation also forms part of their research. A key goal of care is to avoid any post-discharge complications that might make it necessary for a patient to be readmitted after leaving hospital. Once again, opioids emerge as a key factor here, as an ETH Master’s student was able to show in a data analysis under the supervision of Stämpfli and Burden. This analysis revealed that patients who were still being prescribed opioid painkillers at the time of discharge from hospital had an increased risk of being re-hospitalised within 30 days. “The results confirmed what we already knew: that we need to take better care of patients that receive opioids,” says Stämpfli.
According to an analysis of health insurance data – excluding patients who receive opioids for cancer pain and opioid-dependent patients receiving controlled quantities under medical supervision – around one-third of people in Switzerland who are prescribed opioids by a doctor continue taking the medication for over 12 months. Yet evidence suggests that while opioids are useful for treating acute pain and for palliative care, they should not be taken for longer periods of time to treat chronic pain. This is because long-term use may increase sensitivity to pain, hinder rehabilitation or lead to opioid use disorder with the risk of overdose. Recommendations on how to make the best use of these drugs in hospitals are therefore vital. At Kantonsspital Baden, a team is now working with resident clinicians, nurses and primary-care practitioners to put together appropriate guidelines. This will also include advice on how doctors and nurses can work together to ensure that patients eventually come off their opioid medication.
Discharge without opioids
“Patients need better support with opioid therapy; we shouldn’t be leaving them to deal with this alone,” says Burden. This support might include monitoring patients more closely while they are still in hospital, as well as making an earlier start on tapering off the dosage. “Ideally, this tapering process would be completed before the patient leaves hospital, so that they can be discharged without opioids,” says Stämpfli.