Narcotic use in the hospital: reasonably safe?
OBJECTIVE
To determine the causes and frequency of overdoses associated with the administration of opioid analgesics in hospitalized patients.


METHODS
Case series.


METHODS
Two acute care teaching hospitals.


METHODS
Eighty-one hospitalized patients who received naloxone for a clinically suspected narcotic overdose.


METHODS
Three investigators reviewed each patient who received naloxone during a 12-month period. The patients were judged to have a narcotic overdose if caregivers documented an immediate improvement in mental status, respiratory rate, or blood pressure after naloxone administration.


METHODS
The number and causes of narcotic overdoses were determined. The frequency of morphine and meperidine overdoses was calculated. The number of incidents reported using incident or adverse drug reaction reports or the appropriate International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code.


RESULTS
In the 22 overdoses that occurred, 14 (64 percent) were caused by medication prescribing, compounding, or administration errors and potentially were preventable. The remaining eight patients experienced an overdose despite receiving appropriate amounts of opioids. The frequency of overdoses was 0.4 and 0.2 percent of total patients receiving morphine or meperidine, respectively, at the two hospitals. Nonreporting of these narcotic overdoses was frequent. In one hospital, 1 incident report and 3 adverse drug reactions were reported for 17 overdoses. At the second hospital, 1 incident report and 1 adverse drug reaction were reported for 6 overdoses. None of the patient charts included an ICD-9-CM code that documented the problem.


CONCLUSIONS
The causes of overdoses are not limited to prescribing and administration errors. Some patients, despite proper execution of appropriate orders, develop a narcotic overdose. Caregivers must be aware of this problem and monitor patients for a decrease in mental status and respiratory rate. In addition, we conclude that an important number of hospitalized patients develop an overdose even though the frequency is low related to the number of patients receiving narcotics.
Whipple
J K
JK
Department of Surgery, Medical College of Wisconsin, Milwaukee 53226.
Ausman
R K
RK
Quebbeman
E J
EJ
D016907:Adverse Drug Reaction Reporting Systems; D000701:Analgesics, Opioid / Q000009:adverse effects*; D062787:Drug Overdose; D005283:Fentanyl / Q000009:adverse effects; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D008508:Medication Errors; D008614:Meperidine / Q000009:adverse effects; D009020:Morphine / Q000009:adverse effects; D009270:Naloxone / Q000008:administration & dosage / Q000627:therapeutic use; D012308:Risk Management
D000701:Analgesics, Opioid; D009270:Naloxone; D009020:Morphine; D008614:Meperidine; D005283:Fentanyl