Sharek Paul J, McClead Richard E, Taketomo Carol, Luria Joseph W, Takata Glenn S, Walti Beverly, Tanski Marla, Nelson Carla, Logsdon Tina R, Thurm Cary, Federico Frank
Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA.
Pediatrics. 2008 Oct;122(4):e861-6. doi: 10.1542/peds.2008-1011.
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.
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.
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.
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.
与麻醉药品相关的药物不良事件是住院儿童中最常见的药物不良事件。尽管有多项已发表的研究描述了减少麻醉药品所致药物不良事件的干预措施，但尚未有针对儿科麻醉药品相关药物不良事件的大规模协作质量改进工作的报道。本研究的目的是评估在实施了专家小组定义的最佳实践集之后，全协作范围内与麻醉药品相关的药物不良事件发生率。
邀请美国儿童健康公司的所有42家儿童医院参与以医疗保健改进研究所模式开展的质量改进协作项目，旨在减少与麻醉药品相关的药物不良事件。专家小组推荐了一系列已知或疑似可减少与麻醉药品相关的药物不良事件的干预措施，每个地点根据当地需求实施≥1项这些最佳实践。在预先定义的干预强化期（2005年4月1日至2005年12月31日）之后，比较基线期（2004年12月1日至2005年3月31日）和实施期后（2006年1月1日至2006年3月31日）与麻醉药品相关的药物不良事件发生率。次要结局指标包括便秘发生率和与麻醉药品相关的自动发药装置超量使用百分比。
在14个地点的协作项目中，基线期和实施期后的中位与麻醉药品相关的药物不良事件发生率下降了67%。便秘发生率下降了68.9%，自动发药装置超量使用在所有麻醉药品剂量中的占比从10.18%降至5.91%。
在每个参与地点实施≥1项专家小组推荐的干预措施，在为期12个月、涉及14家儿童医院的质量协作项目中，与麻醉药品相关的药物不良事件、便秘及自动发药装置超量使用均显著减少。
