Decreasing narcotic-related adverse drug events
Cincinnati Children’s Hosptial Medical Center is one of 14 children’s hospitals in the United States involved in a collaborative quality improvement effort that has resulted in a demonstrated decrease in narcotic-related adverse drug events.
Approximately 41 percent of all inpatients receive at least one dose of a narcotic. Not surprisingly, narcotic-related adverse drug events (ADEs) are the most common ADEs in hospitalized children. Slightly over one in 10 children have a chance of an adverse drug event; as many as half of all pediatric drug events are caused by narcotics.
Led by the Child Health Corporation of America (CHCA), 14 of the 42 CHCA children’s hospitals came together to try to reduce narcotic-related ADEs. The organizations selected four primary areas on which to test new interventions: constipation, overrides of automatic medication dispensing devices, withdrawal symptoms, and ADEs that occur at the high-risk transfer process.
Using the Institute for Healthcare Improvement’s quality improvement model, the 14 hospitals used small tests of change between April 1, 2005, and March 31, 2006, to determine which changes resulted in improvement.
The interventions that were implemented resulted in a 67 percent reduction in narcotic-related ADEs, indicating that the recommended changes can significantly improve patient outcomes. Constipation rates decreased by 68.9 percent and automated drug-dispensing overrides decreased from 10.18 percent to 5.91 percent of all narcotic doses administered.
The pediatric-specific, evidence-based change practices are now available to any hospital interested in reducing pediatric ADE rates.
The results of the study were published in the October issue of Pediatrics, the journal of the American Academy of Pediatrics.
Cincinnati Children’s participation in the study was led by Joe Luria, MD, medical director of the emergency department, along with Tamara Hutson and Judy Knapp, pharmacists at Cincinnati Children’s. The study was funded by a grant from the Agency for Healthcare Research and Quality.
