Patient Safety

CMS Proposes Measuring Opioid Related Adverse Respiratory Events Why Measure Some Opioid Related Adverse Events and Not Others?

Centers for Medicare & Medicaid Services (CMS) recently released its List of Measures under Consideration.

One of the measures under consideration is MUC17-210 which measures “Hospital Harm Performance Measure: Opioid Related Adverse Respiratory Events”:

“This measure will assess opioid related adverse respiratory events (ORARE) in the hospital setting. The goal for this measure is to assess the rate at which naloxone is given for opioid related adverse respiratory events that occur in the hospital setting, using a valid method that reliably allows comparison across hospitals.”

As stated by CMS, the reason for this measure is because of the known side effects of opioids and the use of naloxone in the event of an opioid related adverse event:

Opiates are critical for the management of pain in hospitalized patients. However, known side effects can lead to serious adverse effects if opiate-treated patients are not properly managed. Many types of opioid related adverse respiratory events (respiratory depression, respiratory arrest, cardiopulmonary arrest, etc.) can potentially be measured electronically. Additionally, naloxone is a strong surrogate to serious adverse events after opiate administration in hospitals, and surveillance and care in administration can reduce adverse events.

MUC17-210 will be measured by taking the number of admissions where there has been administered a narcotic antagonist or respiratory stimulant (unless within 2 hours following a procedure) and dividing this by the number that are discharged.

Although it may be desirable to measure the number of admissions in which a narcotic antagonist or respiratory stimulant has been administered, a consideration of MUC17-210 prompts some questions, including:

  • Why does MUC17-210 exclude occurrences within 2 hours following a procedure?
  • If the proposed measure is “to assess the rate at which naloxone is given for opioid related adverse respiratory events that occur in the hospital setting,” is administration of either a narcotic antagonist or respiratory stimulant, the best way to accomplish this?

What other questions do you have about MUC17-210? What do you think of this proposed CMS measure?

Those wanting to comment to CMS on the measure or other measures under consideration, may submit comments by clicking here.

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