Article Text

PDF
Quality improvement project to reduce perioperative opioid oversedation events in a paediatric hospital
  1. Deborah Vermaire1,
  2. Michelle C Caruso2,
  3. Anne Lesko2,
  4. Elizabeth Kloppenborg3,
  5. Jason Olivea3,
  6. Raymond Pruett3,
  7. Marika Paul3,
  8. Pamela J Schoettker3,
  9. Michael Seid3,4,
  10. Kartik R Varadarajan3,
  11. Patrick H Conway3,5
  1. 1Division of Pain Management, Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  3. 3James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  4. 4Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  5. 5Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  1. Correspondence to Pamela J Schoettker, James M. Anderson Center for Health Systems Excellence, Mail Location R7014, Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA; pam.schoettker{at}cchmc.org

Abstract

Background Narcotics are responsible for many adverse drug events in children and there has been an increase in opioid oversedation events in hospitalised patients.

Objectives To use improvement methods to prevent perioperative opioid oversedation adverse events while continuing to provide appropriate pain control.

Methods Interventions included revising the post-anaesthesia order form so that prescribers could choose only one narcotic and one dose for moderate pain and one narcotic and one dose for severe pain, modifying a nursing tool to provide more objective criteria for assessing patient sedation level, and restructuring the pain service. Clinicians on the Acute Pain Service saw all postoperative patients receiving intravenous patient-controlled analgesia or neuraxial narcotics in the mornings and afternoons and a nurse saw them on weekday evenings.

Results The rate of opioid-related oversedation events decreased from 0.15 per 1000 patient days at baseline to 0.111 during the intervention period to 0.074 in the post-intervention period. The days between events increased from 21.0 to 27.5 to 48.8 during the same periods. The number of opioid-related oversedation events decreased from 22 to 17 to 5 during these periods, respectively.

Conclusions Opioid-related oversedation events decreased over the course of the study. Because the perioperative period is an especially likely time for opioid oversedation events, strict opioid prescribing practices, while maintaining adequate pain control and improved sedation assessment during the perioperative period, were emphasised. The restructured pain service and increased visits by pain team experts were also associated with the reduction in oversedation events.

Statistics from Altmetric.com

Footnotes

  • Funding This work was funded in part by a grant from the Agency for Healthcare Research and Quality (grant number: U18HS016957). Dr Conway is supported by a grant from the Child Healthcare Corporation of America. The funding sources had no involvement in the study design; collection, analysis or interpretation of the data; writing of the report; or decision to submit this paper for publication.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.