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

Voepel-Lewis, Terri PhD, RN*; Zikmund-Fisher, Brian PhD†,‡; Smith, Ellen L. PhD, APN-BC, AOCN§; Zyzanski, Sarah BS*; Tait, Alan R. PhD*

doi: 10.1097/AJP.0000000000000111
Original Articles

Objectives: Evidence of unrelieved childhood pain, adverse drug events (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.

Materials and Methods: A total of 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 (β=−1.48 [95% confidence interval (CI): −1.78, −1.19], P<0.001) as did oversedation (β=−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 (odds ratio (OR) =1.53 [95% CI: 1.14, 2.05], P=0.005). Gastrointestinal effects were more likely to motivate a change in postdischarge opioid administration compared with other ADEs (OR=4.41 [95% CI: 1.91, 10.18], P<0.001), whereas 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.

*Department of Anesthesiology—Pediatric Section

Department of Health Behavior and Health Education, School of Public Health

Department of Internal Medicine

§School of Nursing, University of Michigan, Ann Arbor, MI

The authors declare no conflict of interest.

Reprints: Terri Voepel-Lewis, PhD, RN, Department of Pediatric Anesthesiology, Room 4917 C. S. Mott Children’s Hospital, 1540 E. Hospital Drive, Ann Arbor, MI 48109 (e-mail:

Received January 27, 2014

Received in revised form May 12, 2014

Accepted April 14, 2014

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