The New Zealand safe use of opioids collaborative

The Health Quality & Safety Commission New Zealand is running an 18-month formative collaborative to reduce opioid-related harm in hospitals.

The collaborative aim is to reduce opioid-related harm by 25 percent in district health board* (DHB) hospital’s participating areas, and build capability in medication safety and quality improvement methodology.

The collaborative began in September 2014 and ends in April 2016.
Opioids were chosen for the collaborative because of the associated harm identified in incident reports and a global trigger tool study done in three DHBs (1). The Institute for Healthcare Improvement’s (IHI) collaborative methodology (2) is being used and the IHI is providing external advice.

Participation in the collaborative is voluntary. All 20 DHBs and one private hospital are taking part. Only 18 of the multidisciplinary teams are actively testing interventions using plan-do-study-act cycles. The other three teams are engaged and learning the methodology. Teams include a consumer whenever possible.
Team members in individual hospitals are not funded. The Commission’s national collaborative team provides leadership, guidance and support through visits, phone calls and webinars. The Commission hosted four regional learning events as part of the initial engagement approach. Three national learning sessions when teams come together to learn and share have been hosted and up to three team members from each DHB were funded to attend.
Teams have used local findings to choose the opioid-related harm and the target ward(s) to work on. Most are aiming to reduce harm from opioid-related constipation, but there are teams focusing on respiratory depression, uncontrolled pain and nausea and vomiting.

It is anticipated that a bundle of evidence-based interventions will be identified by the end of the collaborative for implementation in any hospital area (3-5).
The formative collaborative has been independently evaluated. The results are positive and demonstrate improvements in quality improvement capability and medication safety processes, and a reduction in opioid-related harm (6).
Further information and learning session materials are available on the Commission’s website.

* A district health board is responsible for providing or funding the provision of health services in their district. Disability support services and some health services are funded and purchased nationally by the Ministry of Health.


  1. Seddon ME, Jackson A, Cameron C et al. The Adverse Drug Event Collaborative: a joint venture to measure medication-related patient harm. NZMJ 2013; 126 (1368): 9-20. Read on...
  2. Institute for Healthcare Improvement. The Breakthrough Series: Institute for Healthcare Improvement’s (IHI) Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. 2003. Read on... 
  3. Safe use of opioids national collaborative Newsletter April 2015; Issue 1 Read on...
  4. Safe use of opioids national collaborative Newsletter August 2015; Issue 2 Read on...
  5. Safe use of opioids national collaborative Newsletter February 2016; Issue 3 Read on...
  6. Appleton-Dyer S, Edirisuriya N, Soupen A et al. Safe Use of Opioids National Formative Collaborative Evaluation - A report for the Health Quality & Safety Commission November 2016; 78 pages. Read on...