A systematic review of implementation reporting in opioid stewardship literature

Abstract Background The increased awareness of opioid-related harms has resulted in a proliferation of safety strategies and hospital-based quality improvement initiatives, often referred to as ‘opioid stewardship’ interventions. The effective translation of these interventions into more widespread practice relies on understanding and adapting important details of the implementation process. However, as with many healthcare quality improvement studies, the context, and details of the implementation are often absent from the published literature, limiting the scale and spread of practice. Aim To systematically review studies describing opioid stewardship interventions in acute hospital settings and assess the reporting of their implementation. Method A literature search of opioid stewardship interventions in MEDLINE/PubMed, EMBASE, Web of Science and the Cochrane Library from January 2000 to August 2020 was performed. We used Preferred Reporting Items for Systematic Reviews and Meta-analyses. Studies were screened initially for an evaluation of the intervention and subsequently for the inclusion of implementation reporting. The latter was coded using the four Normalisation Process Theory (NPT) domains. Results The database searches identified a total of 4031 publications, of which 372 underwent a full text review and 13 studies were included in the final analysis. The main reasons for exclusion during full-text review were insufficient details of the intervention (n = 90/354, 25%) or implementation (n = 215/354, 61%) to undergo an NPT analysis. When evaluating the potential for scale and spread of an intervention, all studies (n = 13) met the criteria for coherence, cognitive participation, and collective action, but only 3 reported on reflexive monitoring. Conclusion We identified only a small number of opioid stewardship studies that described the implementation processes of the reported interventions. This may be a barrier to effective translation of interventions into broader practice, limiting the potential for impact and benefit to patients and the wider community. Future studies of opioid stewardship interventions should consider using implementation science e.g., NPT across all aspects of knowledge translation and reporting.