Background Opioids are essential medicines for treating pain but are the most common class of medicines that cause harm to inpatients. To address this, The Health Quality and Safety Commission partnered with district health board (DHB) hospitals across New Zealand, in a national formative collaborative to create bundles of care to reduce opioid-related harm.

Objectives To reduce opioid-related harm by 25% in participating areas of hospitals by April 2016 and develop care bundles to reduce opioid-related harm.

Methods Teams used a modified Delphi process to select the best interventions for the individual harm bundle and the composite care bundle. DHB teams identified the elements (interventions) for the harm bundles. Elements were then reviewed by Delphi panels where members scored the elements based on their suitability for inclusion in an emerging composite care bundle. Inclusion of interventions in the care bundles was based on published evidence, local quality improvement data and expert opinion. The collaboratives expert faculty carried out further Delphi rounds to finalise composite care bundle.

Results Four care bundles were developed, including three care bundles for individual harm areas (opioid-induced constipation, opioid-induced ventilatory impairment and uncontrolled pain) and a composite care bundle (covering all the harms as well as opioid-induced nausea and vomiting), supported by a comprehensive how-to-guide to support further opioid safety work. 7/12 hospitals (58 percent) showed greater than 25 percent relative reduction in opioid-related harm, with 6/12 (50 percent) exhibiting a special cause in statistical process control chart.

Conclusions Modified-Delphi technique allowed for transparency surrounding consensus and estimated bundle element impact.