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Pain evaluation in outpatients undergoing diagnostic anesthesia-free hysteroscopy in a teaching hospital: A cohort study
Abstracts
47
2007522481
Organisational structures to treat acute pain
Pain evaluation in outpatients undergoing diagnostic anesthesia-free hysteroscopy in a teaching hospital: A cohort study
2007512619
J Minim Invasive Gynecol 2007;14(6):729—735. Date of publication: November 2007. J.A. de Carvalho Schettini a , M.M. Ramos de Amorim a , A.A. Ribeiro Costa a , L.C. Albuquerque Neto b a Instituto Materno, Infantil de Pernambuco, Recife, Brazil b UNIFESP-Universidade Federal de Sao Paulo, Sao Paulo, Brazil Study objective: To evaluate and determine the main causes for pain occurrence and intensity in outpatients undergoing anesthesia-free hysteroscopy in a medical school hospital. Design: Cohort study (Canadian Task Force classification II-2). Setting: Diagnosis Center of the Instituto Materno-Infantil de Pernambuco. Patients: One hundred seventy-one outpatients undergoing anesthesia-free diagnostic hysteroscopy. Intervention: To assess pain occurrence, intensity, and associated factors reported by patients undergoing anesthesia-free diagnostic hysteroscopy. Measurements and main results: Pain frequency and intensity were determined by visual analog scale (VAS) at the end of the procedure and at 15-, 30-, and 60-min intervals. Data analysis of clinical, obstetric, and gynecologic history and its association with pain was performed. Association through chi2 test (Pearson), risk ratio with 95% CI, and multiple logistic regression were used for statistical analysis. Pain score was higher immediately after the procedure with a median of 6, decreasing to 3, 1, and 0 at 15-, 30-, and 60-min intervals, respectively. Multiple logistic regression was performed, and the only parameters remaining that were significantly associated with pain were menopause, speculum placement, and the absence of previous vaginal delivery. Conclusion: Anesthesia-free diagnostic hysteroscopy is often associated with pain, and it has been determined that menopause, speculum placement, and absence of previous vaginal delivery are factors associated with pain occurrence and intensity. Copyright 2007 AAGL. doi:10.1016/j.acpain.2008.01.020
Medication errors with opioids: Results from a national reporting system J Opioid Manage 2007;3(4):189-194. Date of publication: July 2007. Shore a , R.W. Hicks c , L.L. S.M. Dy a,b , A.D. a Morlock a Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States b Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States c US Pharmacopeia, Rockville, MD, United States Background: Errors may be more common and more likely to be harmful with opioids than with other medications, but little research has been conducted on these errors. Methods: The authors retrospectively analyzed MED-MARX, an anonymous national medication error reporting database, and quantitatively described harmful opioid errors on inpatient units that did not involve devices such as patientcontrolled analgesia. The authors compared patterns among opioids and qualitatively analyzed error descriptions to help explain the quantitative results. Results: The authors included 644 harmful errors from 222 facilities. Eighty-three percent caused only temporary harm; 60% were administration errors and 21% prescribing errors; and 23% caused underdosing and 52% overdosing. Morphine and hydromorphone had a significantly higher proportion of improper dose errors than other opioids (40% and 41% compared with 22% with meperidine). Hydromorphone errors were significantly more likely to be overdoses (78% vs. 47% with other opioids). Omission errors were significantly more common with fentanyl patches (36% compared with 12% for other opioids). Wrong route errors were significantly more common with meperidine (given intravenously when prescribed as intramuscular, 34% vs. 3% for morphine). Oxycodone errors were significantly more likely to be wrong drug errors (24% vs. 11% for other opioids), often because of confusion between immediate- and sustainedrelease formulations. Conclusions: Reported opioid errors are usually associated with administration and prescribing and frequently cause uncontrolled pain as well as overdoses. These patterns of errors should be considered when using opioids and incorporated into
47
2007522481
Organisational structures to treat acute pain
Pain evaluation in outpatients undergoing diagnostic anesthesia-free hysteroscopy in a teaching hospital: A cohort study
2007512619
J Minim Invasive Gynecol 2007;14(6):729—735. Date of publication: November 2007. J.A. de Carvalho Schettini a , M.M. Ramos de Amorim a , A.A. Ribeiro Costa a , L.C. Albuquerque Neto b a Instituto Materno, Infantil de Pernambuco, Recife, Brazil b UNIFESP-Universidade Federal de Sao Paulo, Sao Paulo, Brazil Study objective: To evaluate and determine the main causes for pain occurrence and intensity in outpatients undergoing anesthesia-free hysteroscopy in a medical school hospital. Design: Cohort study (Canadian Task Force classification II-2). Setting: Diagnosis Center of the Instituto Materno-Infantil de Pernambuco. Patients: One hundred seventy-one outpatients undergoing anesthesia-free diagnostic hysteroscopy. Intervention: To assess pain occurrence, intensity, and associated factors reported by patients undergoing anesthesia-free diagnostic hysteroscopy. Measurements and main results: Pain frequency and intensity were determined by visual analog scale (VAS) at the end of the procedure and at 15-, 30-, and 60-min intervals. Data analysis of clinical, obstetric, and gynecologic history and its association with pain was performed. Association through chi2 test (Pearson), risk ratio with 95% CI, and multiple logistic regression were used for statistical analysis. Pain score was higher immediately after the procedure with a median of 6, decreasing to 3, 1, and 0 at 15-, 30-, and 60-min intervals, respectively. Multiple logistic regression was performed, and the only parameters remaining that were significantly associated with pain were menopause, speculum placement, and the absence of previous vaginal delivery. Conclusion: Anesthesia-free diagnostic hysteroscopy is often associated with pain, and it has been determined that menopause, speculum placement, and absence of previous vaginal delivery are factors associated with pain occurrence and intensity. Copyright 2007 AAGL. doi:10.1016/j.acpain.2008.01.020
Medication errors with opioids: Results from a national reporting system J Opioid Manage 2007;3(4):189-194. Date of publication: July 2007. Shore a , R.W. Hicks c , L.L. S.M. Dy a,b , A.D. a Morlock a Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States b Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States c US Pharmacopeia, Rockville, MD, United States Background: Errors may be more common and more likely to be harmful with opioids than with other medications, but little research has been conducted on these errors. Methods: The authors retrospectively analyzed MED-MARX, an anonymous national medication error reporting database, and quantitatively described harmful opioid errors on inpatient units that did not involve devices such as patientcontrolled analgesia. The authors compared patterns among opioids and qualitatively analyzed error descriptions to help explain the quantitative results. Results: The authors included 644 harmful errors from 222 facilities. Eighty-three percent caused only temporary harm; 60% were administration errors and 21% prescribing errors; and 23% caused underdosing and 52% overdosing. Morphine and hydromorphone had a significantly higher proportion of improper dose errors than other opioids (40% and 41% compared with 22% with meperidine). Hydromorphone errors were significantly more likely to be overdoses (78% vs. 47% with other opioids). Omission errors were significantly more common with fentanyl patches (36% compared with 12% for other opioids). Wrong route errors were significantly more common with meperidine (given intravenously when prescribed as intramuscular, 34% vs. 3% for morphine). Oxycodone errors were significantly more likely to be wrong drug errors (24% vs. 11% for other opioids), often because of confusion between immediate- and sustainedrelease formulations. Conclusions: Reported opioid errors are usually associated with administration and prescribing and frequently cause uncontrolled pain as well as overdoses. These patterns of errors should be considered when using opioids and incorporated into