1. High Risk Medications Narcotics and Sedatives Alex Kardos R.Ph. Director of Pharmacy Services Robert Wood Johnson University Hospital Hamilton

2. High Risk Medications Narcotics and Sedatives High Risk Potential: Over-sedation Patient falls Respiratory depression Overdose Death

3. High Risk Medications Narcotics and Sedatives Narcotics: Pain control vs. Risk Demerol Interchange PCA Pumps PCA by proxy Abuse

4. 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

5. 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

6. 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.  Identified lack of knowledge of conversion from meperdine to hydromorphone (morphine 4mg) Implemented Medical Staff Education Program Removed higher strengths from formulary Introduced screening tool for “opiate naïve” patients (max doses)

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8. Continuing: Monitor using YOUR data Use the 80/20 rule Limited resources – many projects Educate – continuously / periodically

9. 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

10. High Risk Medications Narcotics and Sedatives Next Next Step…. at RWJUHH Data received from Rapid Responses and Falls Task Force: N umber of “over” medication events resulting in falls. Combinations of sedatives and other agents

11. 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

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13. Continuing: Monitor using YOUR data Use the 80/20 rule Limited resources – many projects Educate – continuously / periodically

14. 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!

15. 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

16. Resistance is futile ! The Borg – Star Trek The New Generation