Major Study of Opiate Use in Children's Hospitals Provides Simple Steps to Alleviate Harm

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Title: Major Study of Opiate Use in Children's Hospitals Provides Simple Steps to Alleviate Harm
URL: http://www.pslgroup.com/dg/22E3F6.htm
Doctor's Guide
October 6, 2008

NEW YORK -- October 6, 2008 -- Side effects caused by opiates can be decreased in children who are hospitalised for painful ailments, according to a study in the October issue of Pediatrics.

The researchers showed how simple changes to hospital procedures can sharply reduce the harm children suffer from opiates.

"No parent wants their child in the hospital any longer than necessary," said primary author Paul Sharek, MD, Lucile Packard Children's Hospital, Stanford University Medical Center, Stanford, California.

"Our collaborative aim was to decrease adverse drug event rates by 50%. We far exceeded that, which was very exciting."

The study was a yearlong collaboration between 14 US children's hospitals, which documented a 67% drop in harmful events caused by opiates when these procedures were implemented.

Hospital teams followed standard protocols for weaning patients off long-term doses of opiates. They reduced prescription overrides in which nurses gave pain medications to children before double-checking with a pharmacist.

They also worked hard to ensure that all caregivers had up-to-date drug lists when patients were admitted to hospital, transferred to new wards, and sent home. In the study, physicians also routinely added medications to prevent constipation.

"Our focus was not only on errors, but also on harm to patients," said senior author Frank Federico, Institute for Healthcare Improvement, Cambridge, Massachusetts.

Many healthcare providers may view constipation as simply "the cost of doing business" when opiates are given to children, Federico said. But in the study, physicians instead headed off constipation by starting patients on laxatives and stool softeners as soon as they began opiate prescriptions.

The research team checked its progress with quarterly reviews of patient charts at each hospital. In chart reviews, investigators looked for specific clues that a patient had been harmed by opiates. If they found a clue, such as a prescription for naloxone, they read the chart more thoroughly for signs the patient was harmed.

Problems associated with opiates dropped, as the new practices spread through each hospital. In total, the team estimated 14,594 harmful events were averted in participating hospitals during the 1-year study. The changes also saved hospitals money, since harmful events can be costly to resolve and often result in extended hospital stays.

SOURCE: Stanford University Medical Center

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