Opioids-related Adverse Drug Events.

Adverse drug events are one of the major adverse events that occur to hospitalized patients and are one of the most common forms of injury. An adverse drug event is any injury resulting from medication use. Adverse drug events (ADE) may cause loss of function in various body organs and mental or even physical harm. There are various forms of adverse drug events causing various effects. The central argument of this paper is that opioids cause adverse drug events. An analysis of the causes of opioid-related adverse drug events, current statistics of the ADE, methods of preventing the ADE, Root Cause Analysis (RCA) vs. Failure Mode and Effect Analysis (FMEA), and the interdisciplinary team members that should be involved when forming a patient safety team will be discussed in detail.

Opioids Related ADE

Opioids are a class of medications used for pain reduction. Opioids are prescribed by physicians to treat moderate to severe pain. However, they can have severe negative effects when abused. The most common types of opioids include Morphine, Methadone, Hydrocodone, and Oxycodone. Opioid-related adverse drug events are mainly caused by opioid overdose. Opioid-related ADE is one of the adverse drug events that nurses should be concerned about. Opioid-related adverse drug events result from the impact of opioid administration, opioid overdose, prolonged opioid use, and opioid use disorder. According to Urman et al. (2021), one of the most intense opioid-related ADE is respiratory dependence, mainly after sedation. Other adverse effects of opioid medications include dizziness, hypotension, hallucinations, nausea, pneumonia, sedation, and constipation. These Opioid-related ADE are associated with readmissions, increased hospital stay length, and costs and inpatient mortality (Urman et al., 2021).

Statistics Related to the ADE

According to the Centers for Disease Control and Prevention (CDC, n.d.), ADEs are attributed to 1.3 million emergency department visits annually, with 350,000 patients hospitalized after ADEs. As mentioned earlier, one of the major causes of opioid-related ADE is opioid overdose. According to Matson et al. (2021), a mortality and morbidity weekly report in 2021 showed that opioid-related deaths had increased rapidly over time, especially due to the rise of synthetic opioids. In 2019 alone, 70,630 deaths were attributed to opioid overdose, which resulted to opioids related adverse-drug events (Matson et al., 2021). Additionally, a study by Umar et al. (2021) states that approximately 9.1% of the total number of patients who receive post-operative opioids prescription are more likely to experience opioid-related adverse drug events, with older patients, patients have undergone a long surgery and patients with concurrent benzodiazepine being at an increased risk of opioid-related ADE. Therefore, nurses should be more careful when prescribing opioids and advise patients against synthetic opioids.

Methods of Preventing Opioid-Related ADE

There are various methods of preventing opioid-related adverse drug events. The methods include patient education focusing on the dangers of opioid overdose, providing information on current medications, and working with an interdisciplinary team in opioid administration and prescription. Research shows that most patients use opioids after discharge, especially over-the-counter and synthetic opioids, to manage pain post-operation (Herzig et al., 2022). Patient education before the patient is discharged can be used to prevent opioid-related ADE. More so, since opioids are addictive, patient education can help inform patients about the dangers of opioid overdose.

Furthermore, some opioid-related ADE is caused by the use of opioids together with other drugs, such as benzodiazepine. The care provider needs to ask the patient about any other medications they use, including commonly used over-the-counter drugs, before prescribing opioids to prevent opioid-related ADE. Working as a team can also help the care providers prevent opioid-related ADE since they are more likely to be careful and avoid overlooking important details. For instance, a nurse would emphasize to a pain-management specialist the importance of considering the patient’s current medications and if they can work with opioids, thus preventing ADE.

Root Cause Analysis Vs. Failure Mode Effects Analysis

If I worked in risk management, I would choose to use Failure Mode Effect Analysis (FMEA) over Root Cause Analysis (RCA). However, it is worth noting that both are effective risk management tools, but one focuses on problem-solving and the other on problem prevention. I would use an FMEA because it is a structured way of looking ahead to what could happen and thus identifies potential problems, failures, and how they affect the system before an adverse event occurs. Thus, it is the best method to use since it focuses on the problem as well as its effect on the system. A root cause analysis, on the other hand, is structured to investigate and analyze an accident or adverse event after the occurrence and thus does not consider the prevention of the adverse event.

FMEA Interdisciplinary Team Members

While forming an interdisciplinary patient safety team to lead the FMEA process, the essential disciplines I would include are informaticist, pharmacy, and nursing. The pharmacist would be the team leader since he is more informed on drugs and issues leading to adverse drug events. The nurse is the care provider who mainly administers medications to the patients and observes their effects; hence an important team member. More so, the nurses spend more time with the patients and thus would be instrumental in providing patient feedback to the team. Due to the digitization of prescription methods and medication administration, including the informaticist is also vital.

Conclusion

Opioid-related adverse drug event is one of the most common ADE causing harm to patients. Nurses should be more concerned about ADE and play their part in preventing it. Statistics show that ADE is a health concern that needs attention. The FMEA and RCA are used in risk management to prevent adverse events and identify the cause of an adverse event, respectively. Forming an interdisciplinary team to lead the FMEA is vital in effective risk management.

References

Herzig, S. J., Anderson, T. S., Jung, Y., Ngo, L. H., & McCarthy, E. P. (2022). Risk factors for opioid‐related adverse drug events among older adults after hospital discharge. Journal of the American Geriatrics Society70(1), 228-234. https://doi.org/10.1111/jgs.17453

Mattson, C.L., Tanz, L.J., Quinn, K., Kariisa, M., Patel, P.& Davis, N.L.(2021) Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019. MMWR Morbidity and Mortality Weekly Reply, 2021;70:202–207. DOI: http://dx.doi.org/10.15585/mmwr.mm7006a4external icon

The Centers for Disease Control and Prevention. (n.d.) Adverse Drug Events in Adults. https://www.cdc.gov/medicationsafety/adult_adversedrugevents.html

Urman, R. D., Seger, D. L., Fiskio, J. M., Neville, B. A., Harry, E. M., Weiner, S. G., Lovelace, B., Fain, R., Cirillo, J. & Schnipper, J. L. (2021). The burden of opioid-related adverse drug events on hospitalized previously opioid-free surgical patients. Journal of Patient Safety17(2), e76-e83. https://doi.org/10.1097/PTS.0000000000000566

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