Background:

Paediatric healthcare facilities face unique challenges in the medication delivery systems. It is well known that various patient and system factors place paediatric patients at greater risk of experiencing harm from medication errors, and that certain medications have a higher potential to cause harm when used in error.

The Institute for Safe Medication Practices Canada (ISMP Canada) and the Canadian Association of Paediatric Health Centres (CAPHC) are working collaboratively, with support from the Canadian Patient Safety Institute, to enhance the safety of paediatric medication use.

The Paediatrics Opioid Consensus Guidelines for Community and Tertiary Hospitals will be referenced in the 2013 Revised Accreditation Canada Medication Management Standards.

Phase 1 - Identifying the Top 5 Drugs Reported as Causing Harm through Medication Error in Paediatrics

The goals include:

• identify the top medications reported to ISMP Canada as causing harm through medication error in Canadian paediatric healthcare settings;
• identify existing leading practices; and
• analyze the information obtained to develop solutions which form the basis of a medication safety intervention.

Result:
Close to one quarter of all medication incidents voluntarily reported as causing harm were associated with five medications, two of which were opioids.

Next Steps:
Based on the findings from Phase 1, the National Advisory Committee, with representation from across Canada, concluded the project was: To create an intervention that will assist in the implementation of safe medication practice for the delivery of opioids in paediatric settings. This includes all aspects of the opioid medication system from prescribing to storage and administration.

Phase I Report

ISMP Canada Safety Bulletin: Top 5 Drugs Reported as Causing Harm through Medication Error in Paediatrics

Phase 2: Transforming Opioid Delivery in Paediatrics

The primary objectives:

• develop a comprehensive set of recommendations and tools to ensure safe opioid medication practice including, but not limited to, methods of standardization of prescribing and administration, calculation tools, purchasing and storage; and
• utilize an innovative approach by applying human factors expertise, and psychological theory and practice to design strategies for developing support for professionals in safe medication delivery practice.

Result:
A cross-disciplinary working group, in consultation with the national advisory committee, met to coordinate three concurrent activities:

• the development of opioid safety tactics;
• a human factors analysis; and
• a psychological analysis.

Next Steps:

• move to standardized concentrations to reduce calculation and other errors;
• customize recommendations for community and tertiary hospitals; and
• define an optimal psycho-physiological state to deliver opioids.

These next steps point to a new equation for change:

Phase II Report

Phase II Report Appendices

Phase III - Education, Knowledge Translation and Implementation: Paediatric Opioid Safety

Goals & Objectives:
The overarching goal of Phase 3 of the Canadian Paediatric High Alert Medication Delivery Opioid Safety Project was to facilitate the implementation of the CAPHC/ISMPC Paediatric Opioid Safety Consensus Guidelines (Consensus Guidelines) in healthcare organizations serving infants, children and youth.

Main Objectives:

1. To assist all organizations in implementing the Consensus Guidelines created in Phase 2;
2. To identify successful strategies to implement standard concentrations of opioid solutions;
3. To demonstrate the practical applicability of these recommendations within a variety of paediatric healthcare facilities (i.e. Quaternary, Tertiary, and Community-based);
4. To identify barriers to and enablers of practice change;
5. To develop an implementation framework that is flexible enough to be used by organizations at varying stages of readiness.

Result:
It is widely accepted that standardization of practice can improve healthcare efficiencies and outcomes and there appears to be agreement in principle with the CAPHC/ISMP Canada Consensus Guidelines across Paediatric Specialty and Community Hospitals.

A Paediatric Opioid Safety Resource Kit has been developed and posted to the Knowledge Exchange Network to facilitate the implementation of the guidelines. It contains the Consensus Guidelines, references and recommended reading, as well as tools and resources shared from participating organizations. There is an opportunity for individuals to become a member of the Knowledge Exchange Network and begin sharing information as well.

Tools and resources on the Kit have been contributed by participating health care organizations, ISMP Canada, other stakeholder organizations, and or developed by the Steering Committee through consensus with participating organizations.

CAPHC and ISMP Canada are proud to be recognized by Accreditation Canada in the 2013 Medication Management Standards with a reference to the CAPHC/ ISMP Canada Paediatric Opioid Safety Resource Kit.

"Organizations serving paediatric populations are encouraged to implement recommendations from the Canadian Association of Paediatric Health Centres and the Institute for Safe Medication Practices Canada (ISMP Canada) Paediatric Opioid Safety Resource Kit, including the use of standardized concentrations for opioid infusions. Additional strategies to ensure the safe use of high-alert medications such as narcotics (opioids) may be found in Accreditation Canada's High-Alert Medications ROP." (Accreditation Guidelines Required Organizational Practices Handbook - page 45)

Resources:

1. Phase 3 Report: Education, Knowledge Translation and Implementation
2. Knowledge Exchange Network: Paediatric Opioid Safety Resource Kit
3. Consensus Guidelines
4. ISMP Canada Safety Bulletin: Advancing Opioid Safety for Children in Hospitals, March 19th, 2014

Disclaimer:
The publications, presentations, papers and documents herein are provided solely for illustration , instructional purposes and for your general information and convenience. Appropriate, qualified professional advice is necessary in order to apply any information to a healthcare setting or organization. Any reliance on the information is solely at the user's own risk. The Institute for Safe Medication Practices Canada (ISMP Canada), The Canadian Association of Paediatric Health Centres (CAPHC) and contributing hospitals are not responsible, nor liable for the use of the information provided

Partner Organizations

• Canadian Association of Paediatric Health Centres (CAPHC)
• The Canadian Patient Safety Institute (CPSI)