Management of Opioid and Sedative Weaning in Pediatric Congenital Heart Disease Patients: Assessing the State of Practice.
BACKGROUND
Opioid and sedative medications are commonly used to treat pediatric patients with congenital heart disease; however, their use is not without adverse effects. Symptoms of withdrawal can occur if the medications are discontinued abruptly or weaned too quickly.


OBJECTIVE
The aim of this study was to understand and describe the current management of opioid and sedative weaning in pediatric congenital heart disease patients in freestanding children's hospitals across the United States.


METHODS
A Web-based survey of pediatric congenital heart centers was conducted. Survey participants were recruited from the Consortium of Congenital Cardiac Care-Measurement of Nursing Practice. Quantitative data were summarized using frequency and proportions. Qualitative data were summarized using content analysis.


RESULTS
Twelve sites participated in the survey (44% response rate). Methadone was used as a weaning medication at 100% of participating sites, lorazepam at 83% of sites, and clonidine at 75% of sites. Seventy-five percent of sites reported using a clinical assessment tool to monitor withdrawal symptoms. Twenty-five percent of sites used a standardized clinical pathway when weaning opioid and sedative medications. Eighty-three percent of sites will consider discharging a patient to complete the medication wean at home.


CONCLUSIONS
Weaning practices varied across sites. While some similarities were observed among sites, substantial practice variation exists. The majority of sites used a clinical assessment tool to assess for withdrawal symptoms. Few sites reported using a standardized approach to weaning patients. Discharging patients to complete an opioid or sedative wean at home was common practice. Opportunities exist for the development of weaning practice guidelines.
Caitlin O'Connell, DNP, RN, CPNP-AC/PC, is pediatric cardiac surgical nurse practitioner, Boston Children's Hospital, Massachusetts. Sonja Ziniel PhD, MA, is senior survey methodologist, Children's Hospital Colorado, Aurora. Lauren Hartwell, BS, is quality improvement consultant, Boston Children's Hospital, Massachusetts. Jean Connor, PhD, RN, CPNP, FAAN, is director of Nursing Research Cardiovascular & Critical Care Nursing and Patient Services, Boston Children's Hospital, Massachusetts.
Caitlin
C
O'Connell
Sonja
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Ziniel
Lauren
L
Hartwell
Jean
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Connor
D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D002675:Child, Preschool; D004334:Drug Administration Schedule; D006330:Heart Defects, Congenital / Q000451:nursing*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D010146:Pain / Q000188:drug therapy* / Q000451:nursing*; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D014481:United States
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives