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Positive Deviance

McNeese, Kathy MN, RN, CNS

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AJN, American Journal of Nursing: October 2013 - Volume 113 - Issue 10 - p 12
doi: 10.1097/01.NAJ.0000435328.87600.92
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The article about positive deviance was interesting, but I was distracted by the use of meperidine (Demerol) for postoperative pain in the case study.

I'm concerned for the 89-year-old woman featured in this example, because there has essentially been a moratorium on the use of meperidine for pain management for the last 10 to 15 years.

The “American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults”1 states that meperidine use should be avoided because it is “not an effective oral analgesic in dosages commonly used; may cause neurotoxicity; [and] safer alternatives [are] available.”

In Pain Assessment and Pharmacologic Management, Chris Pasero and Margo McCaffery detail the problems associated with this drug, including its toxic metabolite and inappropriate use in elderly patients.2

When confronted with an order for meperidine use in pain management, nurses should work in collaboration with pharmacists and the prescribing physician to review current research and determine a more appropriate medication.

Kathy McNeese, MN, RN, CNS

Duarte, CA

Editor's note: Ms. McNeese is correct, and we appreciate that she has provided AJN with an opportunity to clarify for readers that meperidine was not a good example to use in this fictional case scenario.


1. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. . American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults J Am Geriatr Soc. 2012;60(4):616–31
2. Pasero C, McCaffery M Pain assessment and pharmacologic management. 2011 St. Louis Elsevier/Mosby
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