An intervention to decrease narcotic-related adverse drug events in children's hospitals.
OBJECTIVE
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 >or=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 >or=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.
Sharek
Paul J
PJ
Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA. psharek@lpch.org
McClead
Richard E
RE
Taketomo
Carol
C
Luria
Joseph W
JW
Takata
Glenn S
GS
Walti
Beverly
B
Tanski
Marla
M
Nelson
Carla
C
Logsdon
Tina R
TR
Thurm
Cary
C
Federico
Frank
F
D016907:Adverse Drug Reaction Reporting Systems / Q000458:organization & administration*; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data*; D016903:Drug Monitoring / Q000379:methods; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D009294:Narcotics / Q000009:adverse effects*; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012308:Risk Management; D017751:Safety Management; D014481:United States / Q000453:epidemiology
D009294:Narcotics