Opioid Safety, Respiratory Compromise

A How-To Guide for Reducing Adverse Drug Events Related to Opioids (RADEO)

By Sean Power

Respiratory compromise is the primary antecedent to ‘code blue’, the leading trigger of rapid response calls, and the number one cause of ICU admissions. Respiratory compromise is one of three indicators accounting for 66 percent of all preventable patient safety issues and causes higher mortality rates, longer hospital and ICU stays, and millions of healthcare dollars every year.

Respiratory compromise consists of respiratory insufficiency, distress, arrest, and failure. Respiratory Compromise is a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure or death, but in which specific interventions (enhanced monitoring and/or therapies) might prevent or mitigate decompensation.

RADEO

The incidence of opioid-related respiratory depression is anywhere from 0.16% to 5.2% according to studies. Approximately one in 200 hospitalized postoperative patients experience postoperative respiratory depression. One study found that 16% of inpatient adverse drug reactions were attributable to opioids.

1 in 200 hospitalized postoperative patients experience respiratory depression #ptsafety Click To Tweet

In 2012, The Joint Commission (TJC) issued Sentinel Event Alert 49 on the safe use of opioids in hospitals. The TJC Alert suggested that hospitals develop effective processes, use safe technology, deliver appropriate education and training, and provide effective tools to combat opioid-related adverse drug events.

Against this backdrop, The Society of Hospital Medicine put together the Reducing Adverse Drug Events related to Opioids (RADEO) Implementation Guide. RADEO was developed by an expert panel led by Thomas W. Frederickson, MD, MBA, FACP, SFHM, Medical Director, Hospital Medicine, CHI Health.

“RADEO is a step-by-step guide to assist hospital teams in implementing a successful quality improvement program,” says Dr. Frederickson. “RADEO will help clinicians facilitate safer prescribing practices and reduce adverse events associated with opioid therapy.”

As the RADEO Implementation Guide suggests:

“Perhaps your facility has not had a serious safety event related to opioid administration, but you are a chief medical officer (CMO), chief quality officer (CQO), chief of staff (CoS) or a member of your hospital’s safety committee and have noticed there are frequent activations of your hospital’s rapid response team due to opioid-related sedation or respiratory depression. Many of these events may have resulted in respiratory failure and unplanned transfers to your intensive care unit (ICU).

“Alternatively, you may be a member of your hospital’s pharmacy and therapeutics committee and you have noted that there continues to be a persistent, and what seems to you to be too frequent, use of unplanned opioid reversal agents in your facility. Perhaps you are part of the frontline staff, a nurse or hospitalist who has noticed many ‘near misses’ due to prescribing too high a dose of hydromorphone, or an incorrect patient-controlled analgesia (PCA) setting.

“These errors were caught, but if perhaps the nurse or pharmacist had been less experienced, there would have been patient harm.”

The Physician-Patient Alliance for Health and Safety will feature Dr. Frederickson in an upcoming podcast. Please fill out the form below to be notified when the podcast is available.

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