Background Proficiency in safely converting between opioids is an important skill for doctors and nurses working in palliative care. Rigorous opioid conversion training is rare (Webster, Bremner, Oosenbrug et al., 2017; Spitz, Moore, Papaleontiou et al., 2011), representing potentially widespread unmet educational needs.
Aims Following several drug incidents at our hospice, we aimed to design an educational intervention to facilitate sustained learning of opioid conversion skills. It was intended to be resource-efficient to administer and transferable to community, hospice and hospital settings. The initial target audience was registered nurses (RNs) and junior doctors at a single hospice.
Methods Fifteen clinically relevant questions were formulated to assess baseline ability in opioid dose conversion, calculation of appropriate breakthrough requirements and background dose amendment. A symmetrical final assessment was written using different dose integers. A workbook was written to constructively align with the assessments and evolved following small pilots, incorporating feedback. After a didactic introduction, each section included a calculation example and five self-marked practice questions (41 in total), with increasing complexity. Participants attempted the 32-page workbook after sitting the baseline assessment and before completing the final assessment. Interval reassessment was undertaken to evaluate learning durability.
Results 39 hospice staff have completed the programme to date (26 RNs, 13 doctors). The overall mean baseline test score was 3.3/15 (range 0/15 – 10/15, RN mean 2.8/15, doctor mean 4.2/15). After completion of the workbook, 38 of 39 participants scored 15/15 (mean 14.6/15). The mean score at interval reassessment of 14 RNs (mean six months after workbook completion) was 14.8/15 (range 14/15 – 15/15). Opioid-related patient safety incidents also decreased following workbook introduction.
Conclusions The workbook is an effective educational intervention that significantly improves opioid conversion ability and is sustained six months after completing the training. We plan to introduce the evolving workbook at a local hospital and seven other hospice sites over the next eight months.