Navigation Links
Major study of opiate use in children's hospitals provides simple steps to alleviate harm

STANFORD, Calif. Hospitalized kids with painful ailments from broken bones to cancer are often dosed with strong, painkilling drugs known as opiates. The medications block pain, but they can have nasty side effects. Constipation, for instance, is one side effect that can cause discomfort and even extend a child's hospital stay.

"No parent wants their child in the hospital any longer than necessary," said Paul Sharek, MD, MPH, medical director for quality management and chief clinical patient safety officer at Lucile Packard Children's Hospital at Stanford. Sharek is the primary author of a new study, detailing the first large multicenter trial in children to show a decrease in harm from pain medications. It shows how simple changes to hospital procedures can sharply reduce the harm children suffer from opiates. The study, a yearlong collaboration between 14 U.S. children's hospitals, documented a 67 percent drop in harmful events caused by the pain relievers when these procedures were implemented.

"Our collaborative aim was to decrease adverse drug event rates by 50 percent," Sharek said. "We far exceeded that, which was very exciting."

The findings will appear in the October issue of Pediatrics. The study was organized by the Child Health Corporation of America, a business alliance of 44 North American children's hospitals. Packard Children's Hospital participated in the study, and Sharek, who is also an assistant professor of pediatrics at the Stanford University School of Medicine, led the analysis of its results.

The researchers focused on opiates pain-relieving drugs in the morphine family because they're widely used and harm young patients more often than other drugs. Forty percent of patients at children's hospitals across the U.S. receive opiates. The vast majority of harmful incidents from the drugs, such as constipation and skin itching, are relatively minor. But neither families nor doctors want such problems adding to kids' days in hospital. In addition, rare instances of serious harm from opiates, such as a decreased urge to breathe, provide even greater motivation for hospitals to give opiates safely.

For instance, hospital teams followed standard protocols for weaning patients off long-term doses of opiates. They reduced prescription overrides in which nurses gave pain medications to children before double-checking with a pharmacist. And they worked hard to ensure that all caregivers had up-to-date drug lists when patients were admitted to hospital, transferred to new wards and sent home. The study physicians also routinely added medications to prevent constipation.

"Our focus was not only on errors, but also on harm to patients," said Frank Federico, the study's senior author, who is a pharmacist and medication safety expert with the Institute for Healthcare Improvement in Cambridge, Mass. Patients can be harmed by correctly dosed medications, but in the past that hasn't always been considered a problem. For example, many health-care providers may view constipation as simply "the cost of doing business" when opiates are given to children, Federico said. In this study, physicians instead headed off constipation by starting patients on laxatives and stool softeners as soon as they began opiate prescriptions.

The research team checked its progress with quarterly reviews of patient charts at each hospital. In chart reviews, investigators looked for specific clues that a patient had been harmed by opiates. If they found a clue such as a prescription for naloxone, a drug given to reverse the effects of opiates they read the chart more thoroughly for signs the patient was harmed.

The researchers' efforts began paying off a few months after changes were instituted. Problems associated with opiates dropped, as the new practices spread through each hospital. In total, the team estimated 14,594 harmful events were averted in participating hospitals during the one-year study. The changes also saved hospitals money, since harmful events can be costly to resolve and often result in extended hospital stays.

The collaborative design was an important factor in the study's success, said study co-author Richard McClead, MD, medical director for quality improvement services at Nationwide Children's Hospital in Columbus, Ohio, which is also a member of CHCA. And similar collaborative efforts could be used to tackle other problems in hospital operations, he added. "This shows we can do it," McClead said.


Contact: Erin Digitale
Stanford University Medical Center

Related medicine news :

1. Samarion(SM) to Have Major Presence at the AHCA/NACL/MECF 59th Annual Convention & Expo
2. Facet joint effusion and interspinal ligament edema: major sources of lower back pain
3. The Leukemia & Lymphoma Society Awards Major Grant to Stanford Researcher
4. TrakSoft LLC Announces the Release of Contract Analyst, Version 3.0, a Contract Management System, which Includes a Major User Customization Upgrade
5. Catholic Health Initiatives Makes Major Gift to Support Affordable Housing in the Midwest
6. Majority of children vaccinated against hepatitis B not at increased risk of MS
7. Swiss Institute of Bioinformatics announces major breakthrough
8. E-mergency? Majority of U.S. Consumers Lack Essential Vitamin E
9. Adhesion Prevention New Major Market Opportunity, Haemacure Confirms Effectiveness of its Fibrin Sealant in Second Preclinical Study in Adhesion Prevention in a Bleeding Model
10. Guardian Survey: Men are Twice as Likely as Women to Use Credit Cards to Pay for Major Health Expenses
11. SAFC Pharma(TM) Commits to Major Expansion of High Potency API Production at Madison Site
Post Your Comments:
(Date:11/25/2015)... ... November 25, 2015 , ... Additional breast cancers found with ... according to a study published online in the journal Radiology. Researchers said that ... necessitate a change in treatment. , Breast MRI is the most sensitive technique ...
(Date:11/25/2015)... ... November 25, 2015 , ... Finnleo, a leader in the traditional and far-infrared ... traditional and far-infrared saunas. , For traditional saunas, Finnleo is offering ... sauna wood, and Finnleo uses only European Grade A Nordic White Spruce from sustainably ...
(Date:11/25/2015)... ... November 25, 2015 , ... Dr. John Pierce, Medical Director ... about hair loss treatment with the Capillus272™ Pro laser therapy cap. FDA cleared for ... and fuller hair, without the need for surgery, prescription pills, or topical foams. ...
(Date:11/25/2015)... ... ... For the first time, Vitalalert is donating half of its earnings to ... between the two groups began in 2014 with Vitalalert pledging a portion of every ... founded in 1954 and is an international Christian-based health organization whose mission is to ...
(Date:11/25/2015)... ... November 25, 2015 , ... Dental professionals who would ... OH , are invited to attend Dr. Mark Iacobelli’s Advanced Implant Mentoring (AIM) CE ... Cleveland, OH. , As the co-founders of Advanced Implant Mentoring (AIM), Dr. Iacobelli ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... 26, 2015 Research and Markets ( ... Wound Care Market by Type (Dressings, Therapy Devices, Active ... Facility, Out-Patient Facility), and Geography - Global Forecast to ... --> --> The purpose of ... forecast of the global advanced wound care market. It ...
(Date:11/26/2015)... , November 26, 2015 ... the "Self Administration of High Viscosity Drugs" ... ) has announced the addition of the ... report to their offering. --> Research ... addition of the "Self Administration of High ...
(Date:11/26/2015)... 26, 2015 ... of the  "2016 Future Horizons and ... Surface Marker Testing Market: Supplier Shares, ... their offering.  --> ... the  "2016 Future Horizons and Growth ...
Breaking Medicine Technology: