title: Quality improvement project to reduce perioperative opioid oversedation events in a paediatric hospital.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Division of Pain Management, Department of Anesthesia, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. pam.schoettker@cchmc.org
authors.forename: Deborah
authors.initials: D
authors.lastname: Vermaire
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Caruso
authors.forename: Anne
authors.initials: A
authors.lastname: Lesko
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kloppenborg
authors.forename: Jason
authors.initials: J
authors.lastname: Olivea
authors.forename: Raymond
authors.initials: R
authors.lastname: Pruett
authors.forename: Marika
authors.initials: M
authors.lastname: Paul
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schoettker
authors.forename: Michael
authors.initials: M
authors.lastname: Seid
authors.forename: Kartik R
authors.initials: KR
authors.lastname: Varadarajan
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Conway
mesh_terms: D000293:Adolescent; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D062787:Drug Overdose / Q000517:prevention & control; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D059035:Perioperative Period; D058996:Quality Improvement / Q000458:organization & administration*; D012959:Socioeconomic Factors
chemical_list: D000701:Analgesics, Opioid