title: Meperidine restriction in a pediatric hospital.
abstract: BACKGROUND
  Much has been published revealing concerns surrounding the use of meperidine due to associated toxicities, drug interactions, and lack of proven efficacy. Thus, many adult institutions have chosen to remove or limit the use of this agent, while little has been published about the restriction of meperidine in pediatrics. Many clinicians feel there are still clinical situations in which this agent may be useful.
  
  
  OBJECTIVE
  To describe methods taken in a pediatric hospital to restrict the use of meperidine and review literature describing uses of meperidine as a second-line agent.
  
  
  METHODS
  In our pediatric institution, a policy to restrict the use of meperidine was developed, approved, and implemented. An assessment of meperidine's use 6 months prior to policy implementation was done, along with a postinitiation review of use.
  
  
  RESULTS
  Data revealed that the use of meperidine dropped from 646 doses in 84 patients to 226 doses in 27 patients after restriction, as anticipated. Previous to implementation of these restrictions, orthopedics physicians ordered the majority of meperidine prescriptions, while the gastroenterology service ordered the majority of meperidine prescriptions after implementation of the restriction policy. However, the use of the required form was not widely adopted, with only 30% of practitioners utilizing it postrestriction. Widespread restriction of meperidine and education about use of the form at this institution are still under way.
  
  
  CONCLUSIONS
  Not only are there limited reasons for using meperidine, there are acceptable alternatives for every known indication. Limiting meperidine's use via a restriction policy and/or removal from the institution formulary can help limit the use of this potentially toxic agent in the pediatric patient.
authors.forename: Kim W
authors.initials: KW
authors.lastname: Benner
authors.forename: Spencer H
authors.initials: SH
authors.lastname: Durham