A Quality Assurance Evaluation of Hydromorphone Adverse Events Post-Implementation of a Safety Initiative
| dc.contributor.author | Purivatra, Elsa | |
| dc.contributor.author | Haluk-McMahon, Charlene | |
| dc.contributor.author | El-Masri, Maher | |
| dc.contributor.author | Yrigoyen-Dacruz, Lidia | |
| dc.contributor.author | Duronio, Antoinette | |
| dc.date.accessioned | 2020-09-11T16:19:36Z | |
| dc.date.available | 2020-09-11T16:19:36Z | |
| dc.date.issued | 2019-08 | |
| dc.degree.department | School of Pharmacy | en |
| dc.description.abstract | Purpose: Hydromorphone is a potent opioid that may lead to respiratory and central nervous system depression prompting naloxone use. The primary objective of this study was to evaluate whether a safety initiative implemented at Windsor Regional Hospital involving interchanging hydromorphone intravenous or subcutaneous doses of 1 mg or greater to low dose (0.5 mg) in opioid naïve, medical and surgical patients was associated with naloxone events. The secondary objective was to assess whether there was a compromise in patient pain control with the low dose. Methods: We conducted a retrospective, multicenter, observational study of medical and surgical opioid-naïve patients admitted to Windsor Regional Hospital who received intravenous or subcutaneous hydromorphone within an eighteen-month timeframe. To determine if there is an association between naloxone events and implementation of the safety initiative, we compared patients who experienced a naloxone event (cases) with patients who did not experience a naloxone event (controls) in approximately 1:4 ratio. Efficacy outcomes assessed changes in patient pain control before and after interchange policy implementation (i.e. need for increase in dose, frequency or additional analgesics). Results: Of the 4343 patients who received hydromorphone, 143 opioid naïve patients were included in the final analysis. Of the 27 patients who experienced a naloxone event, 0% of patients were interchanged. In contrast, of the 116 patients who did not experience a naloxone event, 52% were interchanged (OR = 0, 95% 0 to 0.13, p<0.01). There were no significant differences in terms of patient pain control before and after interchange policy implementation. Conclusions: The pharmacist-led safety initiative of interchanging all opioid naïve patients to low dose hydromorphone was not associated with naloxone events and did not compromise patient pain control. | en |
| dc.identifier.uri | http://hdl.handle.net/10012/16282 | |
| dc.language.iso | en | en |
| dc.publisher | University of Waterloo | en |
| dc.subject | hydromorphone | en |
| dc.subject | naloxone | en |
| dc.subject | opioid | en |
| dc.subject | safety | en |
| dc.subject | pain management | en |
| dc.title | A Quality Assurance Evaluation of Hydromorphone Adverse Events Post-Implementation of a Safety Initiative | en |
| dc.type | Residency Paper | en |
| uws.affiliation.institution | Windsor Regional Hospital | en |
| uws.contributor.affiliation1 | Faculty of Science | en |
| uws.peerReviewStatus | Unreviewed | en |
| uws.published.city | Waterloo | en |
| uws.published.country | Canada | en |
| uws.published.province | Ontario | en |
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