Abstract
Background: Codeine is an opioid analgesic requiring hepatic conversion to morphine via CYP2D6 to provide analgesic effect. CYP2D6 population polymorphisms cause unpredictable conversion to morphine. Multiple reports of death or adverse events in children receiving codeine has led to increased calls for discontinuation of use in children. Our Pediatric Oncology Program volunteered to pilot codeine removal. When looking for implementation strategies for this practice change, neither successful implementation nor barriers to change had been reported. Objectives: To evaluate whether prescription of codeine was reduced, assess the attitudes of health professionals at different points during practice change, determine if our educational tools were successful in aiding this change. Methods: An electronic survey was created and distributed to all Pediatric Oncology Team members prior to implementation, and 3 and 6 months after. In our hospital, all opioids are dispensed from automated cabinets. Reports assessing the number of codeine doses dispensed in a 2 month period prior to and following implementation were obtained. Results: Survey response rate was 55%. In the assessment points prior and post implementation, 249 codeine doses were administered to 35 patients, 7 doses were administered to 3 patients respectively. Major concerns about provincial triplicate prescription barriers and utilization of other opioids were minimal (22%) but still decreased 6 months after implementation (8%). Barriers to successful implementation initially rated significant were attitudes of other health professionals (42%) and perceptions of parents/families (60%). Both showed marked improvement 6 months after implementation (25%). Education strategies for implementation were well-utilized and rated by participants as beneficial. Eighty-two percent of respondents rated the practice change as easy. Conclusion: Removal of codeine was successful using a diverse, planned education program. Initially identified barriers did not hinder implementation. Our intent is to use these results to implement a similar practice change within the entire children's hospital.
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
practice change, codeine, attitudes
Recommended Citation
Black, Karina L.; Venner, Mary Anne; Shepherd, Jennifer; Romanick, Marcel; Belletrutti, Mark; and Perry, Shirley, "Removal of Codeine in Pediatric Oncology: A Qualitative Evaluation of Success and Attitudes" (2012). INRC (Congress). 139.
https://www.sigmarepository.org/inrc/2012/presentations_2012/139
Conference Name
23rd International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Brisbane, Australia
Conference Year
2012
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
All permission requests should be directed accordingly and not to the Sigma Repository.
All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Acquisition
Proxy-submission
Removal of Codeine in Pediatric Oncology: A Qualitative Evaluation of Success and Attitudes
Brisbane, Australia
Background: Codeine is an opioid analgesic requiring hepatic conversion to morphine via CYP2D6 to provide analgesic effect. CYP2D6 population polymorphisms cause unpredictable conversion to morphine. Multiple reports of death or adverse events in children receiving codeine has led to increased calls for discontinuation of use in children. Our Pediatric Oncology Program volunteered to pilot codeine removal. When looking for implementation strategies for this practice change, neither successful implementation nor barriers to change had been reported. Objectives: To evaluate whether prescription of codeine was reduced, assess the attitudes of health professionals at different points during practice change, determine if our educational tools were successful in aiding this change. Methods: An electronic survey was created and distributed to all Pediatric Oncology Team members prior to implementation, and 3 and 6 months after. In our hospital, all opioids are dispensed from automated cabinets. Reports assessing the number of codeine doses dispensed in a 2 month period prior to and following implementation were obtained. Results: Survey response rate was 55%. In the assessment points prior and post implementation, 249 codeine doses were administered to 35 patients, 7 doses were administered to 3 patients respectively. Major concerns about provincial triplicate prescription barriers and utilization of other opioids were minimal (22%) but still decreased 6 months after implementation (8%). Barriers to successful implementation initially rated significant were attitudes of other health professionals (42%) and perceptions of parents/families (60%). Both showed marked improvement 6 months after implementation (25%). Education strategies for implementation were well-utilized and rated by participants as beneficial. Eighty-two percent of respondents rated the practice change as easy. Conclusion: Removal of codeine was successful using a diverse, planned education program. Initially identified barriers did not hinder implementation. Our intent is to use these results to implement a similar practice change within the entire children's hospital.