An Intervention to Decrease Narcotic-Related Adverse Drug Events in Children's Hospitals

• Published in: Pediatrics (Evanston) 2008-10, Vol.122 (4), p.e861-e866
• Main Authors: Sharek, Paul J, McClead, Richard E., Jr, Taketomo, Carol, Luria, Joseph W, Takata, Glenn S, Walti, Beverly, Tanski, Marla, Nelson, Carla, Logsdon, Tina R, Thurm, Cary, Federico, Frank
• Format: Article
• Language: English
• Subjects: Adverse Drug Reaction Reporting Systems - organization & administration; Child; Child, Hospitalized - statistics & numerical data; Drug Monitoring - methods; Follow-Up Studies; Hospitals; Hospitals, Pediatric - statistics & numerical data; Humans; Incidence; Intervention; Medication Errors - prevention & control; Medication Errors - statistics & numerical data; Narcotics; Narcotics - adverse effects; Opioid-Related Disorders - epidemiology; Opioid-Related Disorders - prevention & control; Patient safety; Pediatrics; Retrospective Studies; Risk Management; Safety Management; Side effects; United States - epidemiology
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2008-1011

Narcotic-related adverse drug events are the most common adverse drug events in hospitalized children. Despite multiple published studies describing interventions that decrease adverse drug events from narcotics, large-scale collaborative quality improvement efforts to address narcotic-related adverse drug events in pediatrics have not been described. The purpose of this study was to evaluate collaborative-wide narcotic-related adverse drug event rates after a collection of expert panel-defined best practices was implemented. All 42 children's hospitals in the Child Health Corporation of America were invited to participate in the Institute for Healthcare Improvement-style quality improvement collaborative aimed at reducing narcotic-related adverse drug events. A collection of interventions known or suspected to reduce narcotic-related adverse drug events was recommended by an expert panel, with each site implementing >or=1 of these best practices on the basis of local need. Narcotic-related adverse drug event rates were compared between the baseline (December 1, 2004, to March 31, 2005) and postimplementation periods (January 1, 2006, to March 31, 2006) after an a priori-defined intervention ramp-up time (April 1, 2005, and December 31, 2005). Secondary outcome measures included constipation rates and narcotic-related automated drug-dispensing-device override percentages. Median narcotic-related adverse drug event rates decreased 67% between the baseline and postimplementation time frames across the 14-site collaborative. Constipation rates decreased 68.9%, and automated drug-dispensing-device overrides decreased from 10.18% to 5.91% of all narcotic doses administered. Implementation of >or=1 expert panel-recommended interventions at each participating site resulted in a significant decrease in narcotic-related adverse drug events, constipation, and automated drug-dispensing-device overrides in a 12-month, 14-site children's hospital quality collaborative.