Published online October 1, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. e861-e866 (doi:10.1542/peds.2008-1011)
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ARTICLE

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

Paul J. Sharek, MD, MPHa,b, Richard E. McClead, Jr, MDc, Carol Taketomo, PharmDd, Joseph W. Luria, MDe, Glenn S. Takata, MD, MSf,g, Beverly Walti, MSN, CPNP, CNSh, Marla Tanski, PharmDi, Carla Nelson, MPH, CPHQj, Tina R. Logsdon, MSk, Cary Thurm, PhDk and Frank Federico, PharmDl

a Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
b Department of Quality Management, Lucile Packard Children's Hospital, Palo Alto, California
c Department of Pediatrics, Ohio State University School of Medicine, Columbus, Ohio
d Department of Pharmacy
f Division of General Pediatrics and Patient Safety Program, Childrens Hospital Los Angeles, Los Angeles, California
e Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
g Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California
h Department of Nursing, Children's Hospital of Orange County, Orange, California
Departments of i Pharmacy
j Quality Management, All Children's Hospital, St Petersburg, Florida
k Performance Improvement Division, Child Health Corporation of America, Shawnee Mission, Kansas, and Quintiles, Overland Park, Kansas
l Institute for Healthcare Improvement, Cambridge, Massachusetts

OBJECTIVES. 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.

METHODS. 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 ≥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.

RESULTS. 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.

CONCLUSIONS. Implementation of ≥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.

Key Words: adverse drug event • narcotic • pediatrics • harm • patient safety

Abbreviations: ADE—adverse drug event • CHCA—Child Health Corporation of America • IRB—institutional review board • IHI—Institute for Healthcare Improvement

Accepted Jun 17, 2008.


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