Alarm Fatigue, Opioid Safety, Patient Stories, Respiratory Compromise

PPAHS Joins Anesthesia Patient Safety Foundation in Call for a “Paradigm Shift” in Opioid Safety

by Sean Power
February 19, 2014

“It’s time for a change in how we monitor postoperative patients receiving opioids,” declares Dr. Robert Stoelting, president of the Anesthesia Patient Safety Foundation (APSF). “We need a complete paradigm shift in how we approach safer care for postoperative patients receiving opioids.”

The APSF recently released a video highlighting the conclusions and recommendations that came out of a 2011 conference on opioid-induced ventilatory impairment. You can find the video here.

In the video, APSF states that continuous electronic monitoring of oxygenation and ventilation, when combined with traditional nursing assessment and vigilance, will greatly decrease the likelihood of unrecognized, life threatening, opioid induced respiratory impairment.

The clinical significance continuous electronic monitoring offers is the opportunity for prompt and predictable improvement in patient safety.

According to Lenore Alexander, founder and executive director of Leah’s Legacy, a patient safety organization focused on safe opioid use:

“A monitor would have saved my child’s life. I have made the goal of continuous postoperative monitoring my commitment.

“All that stands between us and universal post op monitoring is the will to require it.”

In the APSF video, health experts warned of the risks of selectively monitoring some patients.

According to Nikolaus Gravenstein, MD, Professor of Anesthesia, University of Florida School of Medicine, APSF Committee on Technology:

“Who should be monitored electronically? I would say any inpatient but certainly any inpatient prescribed narcotics, because if they are prescribed they can be received.”

According to Michael DeVita, MD, Critical Care Medicine, St. Vincent’s Hospital:

“You need to absolutely require a continuous monitoring system if it’s your goal to prevent every possible death. Who should be monitored? Everyone.”

Mark Montoney, MD, MBA, Executive Vice President and Chief Medical Officer, Vanguard Health Systems, also argued that the costs of continuous electronic monitoring should not be an impediment to saving patients’ lives:

“No matter where you set the thresholds, I think you get too many false negatives and false positives. We either get this sense of security that everything is all right, when in fact it may not be. Or, we have these alarms that are going off that eventually our caregivers get desensitized to.

“I would agree with the notion of continuous monitoring. I don’t see the value of intermittent monitoring. I really stop short at talking about high-risk patients because, while we can define them in a category, we’re going to get burned when we try to differentiate because you don’t always know who’s a high-risk patient.

“One of the questions that’s been asked is, ‘Boy, this is going to cost a lot, isn’t it?’ And I say, ‘Can we not afford to do this?’”

The Physician-Patient Alliance for Health and Safety (PPAHS) applauds the APSF for its goal to prevent every possible death and adverse event associated with opioid induced ventilatory impairment and PCA therapy.

14 thoughts on “PPAHS Joins Anesthesia Patient Safety Foundation in Call for a “Paradigm Shift” in Opioid Safety

  1. In todays world, where opioid addiction and overdose is being taken very seriously,how can we ignore the patients dying of opioid overdoses , accidentally , in our hospitals. This does not require an invention, it doesnt require a cultural change.All that it will take for our children and parents to stop dying of preventable drug overdoses while recovering from surgery in hospitals is the will to demand it. Anybody receiving heroin like drugs in the hospital must be continuously monitored, by an electronic device, as well as nurses. How many more stories like Leah’s will it take?

  2. Well said, Lenore. As has been said before, electronic monitoring provides nurses with a technological safety net. Continuous monitoring plus nursing vigilance is the best way to prevent deaths associated with opioids and PCA.

  3. The APSF should be commended for their progressive stand on continuous monitoring during opioid use and for setting the bar at preventing every possible death. Leah’s Legacy has worked tirelessly to save others from tragic outcomes from post-operative opioid use. Lenore Alexander states it so perfectly – “All that stands between us and universal post op monitoring is the will to require it” and the moral obligation to do the right thing for each patient during every hospitalization.

  4. Sean,
    Outstanding article and so pleased to see the active stance APSF has taken in this critical health care issue of the use of continuous electronic monitoring use during opioid delivery to the patient. I think it is of significant clinical importance in order to prevent serious adverse events and mortality in patieitn on opioids and the opioid naive patient. This cause needs to be supported in health care and as we read Leah’s Legacy it is even more pronounced and leaves it mark in the esseence of being a true patient advocate. I am so pleased to see coments written on this wonderful article.
    I encourage clinicians to download the PCA safety Checklist on the PPAHS web site it is well worth the effort of institutions as a “Safety Check”- it may save a life!

    Thanks Lynn Razzano RN, MSN ,ONCC Clinical Nurse Consultant PPAHS

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