Pediatric Adverse Event Risk Reduction for High Risk Medications in Children and Adolescents: Improving Pediatric Patient Safety in Dental Practices

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A narrow margin of safety exists in the care of pediatric dental patients, and this often occurs in practice settings with less information on patients’ full medical history that is crucial for the safe practice of dentistry. Although dentists administer and prescribe a limited number of medications in routine practice, many of these medications carry a high risk for human error and complications. High-risk medications are frequently prescribed and administered by dentists to children and have resulted in serious unintended consequences, including adverse events – such as death – during conscious sedation or general anesthesia, and the overprescribing of opioids. More than 100,000 pediatric dental sedations are performed annually in the U.S. The most common medications used for these procedures are benzodiazepines, opioids, and general anesthetics. All are associated with serious adverse events, including hypoxemia, respiratory depression, airway obstruction and death. Most Americans have their first exposure to opioids in their youth following third molar extraction. This use of prescription opioids has been associated with an increased risk of opioid misuse into adulthood. These trends in early adulthood and case reports of pediatric deaths occurring following dental sedation procedures make clear the urgency to understand and implement best patient safety practices in the dental care of children. Yet, U.S. data on medication prescribing patterns of pediatric dentists, evidence-based prescribing and community dental providers’ attitudes toward implementation of pediatric patient safety is scarce. Although efforts and resources exist to curtail overprescribing of opioids and best patient safety practices in pediatric sedation, most interventions are focused on physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) and may fail in broader implementation to pediatric dental practices. The objective of this mixed- methods study is to improve high-risk pediatric prescribing patterns among dentists by identifying current prescribing patterns associated with poor health outcomes that could be targeted for intervention. To accomplish this objective we aim to: (1) determine the extent to which high-risk medications are prescribed to pediatric dental patients and rates of poor patient outcomes in a population-based sample of commercially- and publicly-insured children; (2) [Examine] dentists’ attitudes towards medication safety when prescribing high- risk medications and decision-making when prescribing high-risk medications for pediatric patients; and (3) [Develop and pilot a checklist to facilitate treatment decisions that best promotion medication safety in pediatric dental care]. We anticipate this study will close the knowledge gap on dental prescribing patterns of high-risk medications to children, association with poor patient outcomes, and determine dentist perceptions of the safety of these medications. [This mixed-methods study will design and implement an evidence-based intervention to minimize harms from high-risk medications and improve safe dental practice to children and adolescents.]