857

Abstract

Introduction: Ohio's pediatric hospital collaborative defines serious harm to include level 6-9 adverse drug events in addition to serious safety events, hospital acquired infections, grades 3-4 pressure ulcers, serious falls, codes outside the intensive care unit, and serious peripheral IV infiltrates. Our hospital set a goal to decrease all events that pose serious harm. When the level 6-9 adverse drug events were analyzed, opioid induced oversedation requiring the administration of naloxone was found to be the most prevalent. Due to the need for sedation during mechanical ventilation and pain control in critically ill patients, the inpatient unit with the most naloxone administrations was the pediatric intensive care unit (PICU). A subgroup was formed to analyze historical data, identify problems areas, and devise and implement a plan to reduce its incidence within the PICU. Methods: A detailed review of oversedation cases occurring in the PICU over the previous 2 years was performed and identified dose stacking, inappropriate initial doses, and oversedation at the time of extubation as areas for improvement. Interventions included creating new computerized order sets for acute pain, sedation, and withdrawal management with more detailed initial, maximum, and dose titration recommendations, implementation of more objective sedation and withdrawal assessment tools with target ranges, and creating non-weight based dosing entries for adult or adult size patients to avoid overdosing. In addition, these areas became a focus for resident, fellow, and nursing education. Results: Opioid oversedation events requiring naloxone reversal decreased overall from 57 events from 7/1/2011 to 6/30/2012 (fiscal year 2012) to 43 events between 7/1/2012 to 6/30/2013 (fiscal year 2013) hospital wide. With the interventions described above, the number of events in the PICU decreased from 18 events (31.6%) in fiscal year 2012 to 2 events (4.7%) in fiscal year 2013. Conclusions: A standardized approach to sedation, pain management, and withdrawal prevention lead to fewer opioid-related oversedation events in our pediatric intensive care unit. Continued data collection will determine if our interventions reduce length of intubation and opioid exposure and will help determine if adjustments are needed to the current protocol.