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Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000111
Original Article: PDF Only

Opioid-related Adverse Drug Events: Do Parents Recognize the Signals?.

Voepel-Lewis, Terri PhD, RN; Zikmund-Fisher, Brian PhD; Smith, Ellen Lavoie PhD, APN-BC, AOCN®; Zyzanski, Sarah BS; Tait, Alan R. PhD

Published Ahead-of-Print
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Objectives: Evidence of unrelieved childhood pain, adverse drug effects (ADE) and deaths suggest that parents may inadequately respond to pain and opioid-related ADE signals. This study examined parents' recognition and response to pain and ADE signals using both, dynamic hypothetical scenarios and real at-home opioid decisions.

Methods: 514 parents whose children required prescription opioids after discharge were surveyed. Parents made analgesic decisions for 4 hypothetical scenarios wherein the child's pain level and ADE symptoms were altered. After discharge, parents recorded their child's real pain levels, ADEs, and their analgesic decisions. Mixed effects logistic regression examined the influence of pain and ADE signals on parents' opioid decisions.

Results: Pain intensity had a main effect on parents' hypothetical and real decisions to give opioids (P<=0.001). Nausea/vomiting influenced the decision to give the prescribed opioid dose ([beta]=-1.48 [95% CI -1.78, -1.19], P<0.001) as did oversedation ([beta]=-1.02 [95% CI -1.30, -0.75], P<0.001), however, parents were more likely to give the prescribed dose for oversedation than nausea/vomiting (OR=1.53 [95% CI 1.14, 2.05], P=0.005). Gastrointestinal effects were more likely to motivate a change in post-discharge opioid administration compared to other ADEs (OR=4.41 [95% CI 1.91, 10.18], P<0.001), while sedation symptoms did not (OR=0.46 [95% CI 0.21, 1.04], P=0.06).

Discussion: Findings demonstrated that many parents failed to withhold a prescribed opioid dose for oversedation, suggesting a lack of awareness regarding this potentially serious ADE. Strategies to improve parents' recognition of oversedation and its potential consequences are warranted to improve opioid safety.

(C) 2014 by Lippincott Williams & Wilkins

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