• Clin J Pain · Mar 2015

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

    • Terri Voepel-Lewis, Brian Zikmund-Fisher, Ellen L Smith, Sarah Zyzanski, and Alan R Tait.
    • *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.
    • Clin J Pain. 2015 Mar 1;31(3):198-205.

    ObjectivesEvidence 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 MethodsA 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.ResultsPain 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).DiscussionFindings 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.

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