Opioid Safety, Respiratory Compromise

Respiratory Therapists Are Integral to Reducing Opioid-Related Adverse Events

Harold Oglesby - Celebrating 10 Years's Event Free

In a recent interview with Harold Oglesby, RRT, Manager, The Center for Pulmonary Health, Candler Hospital, St. Joseph’s/Candler Health System (SJ/C), our discussion focused on the success factors that contributed to SJ/C’s 12 years free from opioid-related adverse events.

During the interview, Mr. Oglesby highlighted five key learnings from his experiences in implementing and continuously improving SJ/C’s QI initiative.  One of these learnings was the importance of involving Respiratory Therapists (RT) throughout the process.

RTs Are Patient Safety Touchpoints

In the interview, Mr. Oglesby mentions that effective implementation of capnography monitoring was one of the key challenges tackled by SJ/C.  To do so, he formed a cross-disciplinary team of subject-matter experts from across the hospital to lead the charge.  

RTs served as one of the cornerstones of the team, bridging the gap between the operating room, patients in recovery, and the staff responsible for their care.  Says Mr. Oglesby:

“One of the things that we found with our respiratory therapist is that we looked to and leaned on them for their expertise.  We made them an integral part by having them monitor the patients.  And, what they actually do is go on the floor and see these patients at least once during the shift. Or, if a nurse has an issue with the capnography device, or if she has questions about a patient, she can call a respiratory therapist, they will come up there and monitor the patient.”

In addition to serving as an escalation point for monitoring issues, RTs also play an active role while performing rounds at SJ/C.  This includes regular assessments of patients’ key respiratory metrics, including respiratory rate, respiratory effort, SpO2 , and end-tidal CO2.  Particularly with capnography monitoring, trend analysis is crucial to detecting the signs of respiratory depression.

Mr. Oglesby stressed that it was important to “treat the patient, not the monitor”.  RTs can play a key role in this by interpreting trends observed via the monitor in the context of individual patients’ needs; these include any medication administered, as well as the patient’s sedation scale, level of consciousness, activity, and their pain score.

Involving RTs Reduces Alarm Fatigue

An additional patient safety benefit to having RTs active in the patient monitoring process is their positive effect in reducing alarm fatigue.  Mr. Oglesby revealed that their patient monitor default settings are set wide.  RTs then visit patients and and adjust alarm settings based on what’s happening with the patient at bedside.

Mr. Oglesby elaborates on several scenarios that show how important this can be:

“So, if we have a COPD patient on the floors and, say, his CO2 on a normal day is 55, we know that we can increase his high end tidal CO2 alarms. Conversely, if we have a patient that’s “walky, talky” and running lower end tail CO2’s, then we can manipulate the settings to meet the patient’s needs.  

[S]ome patients change from day to night.  So, when you’re asleep, you may have an increase in your CO2, you may breathe a little bit slower, but we again adjust those alarms to meet the patient’s need at that time.”

The result not only puts patient safety at the forefront, but also cuts down on the number of nuisance alarms that staff need to respond to.

Conclusion

One of the underlying takeaways from the PPAHS’ latest interview with Mr. Oglesby is the importance of a hospital-wide approach to patient safety.  SJ/C’s 12 years of success would not have been possible without involving key decision makers from across the organization.  This includes involving nurses, pharmacists, physician leadership, and respiratory therapists in jointly developing processes, monitoring algorithms, and education strategies.

Says Mr. Oglesby:

“[H]aving everybody initially together, not only aided in having the right people at the table, but it also gave everybody on the team some ownership of the process. So, nobody felt like they were being imposed on or anything was pushed on them and everybody had some stake in the transition.  And, everybody knew that the reason we were doing it was for patient safety.”

For readers who have not yet listened to our interview with Harold Oglesby, RRT, please click here.

 

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