Transcript High Risk Medications Narcotics and Sedatives

High Risk Medications
Narcotics and Sedatives
Alex Kardos R.Ph.
Director of Pharmacy Services
Robert Wood Johnson University
Hospital Hamilton
High Risk Medications
Narcotics and Sedatives
High Risk Potential:
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Over-sedation
Patient falls
Respiratory depression
Overdose
Death
High Risk Medications
Narcotics and Sedatives
Narcotics:
 Pain control vs. Risk
 Demerol Interchange
 PCA Pumps
PCA by proxy
 Abuse
High Risk Medications
Narcotics and Sedatives
Do you have a problem? (of course you do)
Where to find data sources:
 MUEs
 Codes and Rapid Responses
 Rescue Drugs
 Medical Records (E-Codes)
 Incident Reports
 Staff
High Risk Medications
Narcotics and Sedatives
Next Next Step…. at RWJUHH
High Risk Policy “PINCH”
N = Narcotic PCA
 Prescribers must order from Standard form
 Pharmacy controls distribution – Standard concentrations
 Programming pumps require TWO nurses
High Risk Medications
Narcotics and Sedatives
Next Next Step…. at RWJUHH
Data received from Rapid Responses:
High number of “over” medication events
Common thread – hydromorphone use.
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Identified lack of knowledge of conversion from
meperdine to hydromorphone (morphine 4mg)
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Implemented Medical Staff Education Program
Removed higher strengths from formulary
Introduced screening tool for “opiate naïve” patients
(max doses)
High Risk Medications
Narcotics and Sedatives
# of Rapid Responses due to opiates
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
6
'0
h
4t
6
d'
0
3r
'0
6
2n
d
6
1s
t'0
5
h'
0
4t
3r
d
'0
5
# RR for
Opiates
High Risk Medications
Narcotics and Sedatives
Continuing:
 Monitor using YOUR data
 Use the 80/20 rule
 Limited resources – many projects
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Educate –
continuously / periodically
High Risk Medications
Narcotics and Sedatives
Sedatives:
 Used for sleep, anxiety, agitation
 Over use common
 Issues bordering on “chemical
Restraint”
 No antidote – only sedation reversal
agent
High Risk Medications
Narcotics and Sedatives
Next Next Step…. at RWJUHH
Data received from Rapid Responses
and Falls Task Force:
 Number of “over” medication events resulting
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in falls.
Combinations of sedatives and other agents
High Risk Medications
Narcotics and Sedatives
Next Next Step…. at RWJUHH
 Identified medications (not only sedatives) with
high potential for “falls”
 Designed fall assessment tool (nursing)
 Implemented “Falling Star program”
 Warning on computer generated MAR by drug of
“fall” rating
High Risk Medications
Narcotics and Sedatives
2005 Fall Data
4.5
4
3.5
#
Falls/1000
pt days
3
2.5
2
Jan
'05
1st
Qtr
2nd
Qtr
3rd
Qtr
4th
Qtr
EOY
High Risk Medications
Narcotics and Sedatives
Continuing:
 Monitor using YOUR data
 Use the 80/20 rule
 Limited resources – many projects

Educate –
continuously / periodically
High Risk Medications
Narcotics and Sedatives
Conclusion:
Measure what is going on in your facility
Make it simple to do the right thing
Plan for errors in advance
USE YOUR DATA!
High Risk Medications
Narcotics and Sedatives
“One of the definitions of insanity
is continuing to do the same thing
and expecting different results.”
-Albert Einstein
Resistance is futile !
The Borg – Star Trek The New Generation