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Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000111
Original Articles

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*

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Abstract

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.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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