Opioid Safety, Respiratory Compromise

Today’s Must-Have: Capnography Monitoring During Conscious Sedation Clinical Education Podcast with Drs. Matt Kurrek and Richard Merchant

Today, the Physician-Patient Alliance for Health Safety released a clinical education podcast with Matt Kurrek, MD, FRCPC (Professor, Department of Anesthesia, University of Toronto) and Richard Merchant, MD, FRCPC (Clinical Professor, University of British Columbia, Department of Anesthesia, Pharmacology & Therapeutics).

Drs. Kurrek and Merchant coauthored an editorial, “Yesterday’s Luxury, Today’s Necessity” after the Canadian Anesthesiologists’ Society [CSA] published its revised 2012 guidelines to the practice of anesthesia. The CSA guidelines recommend capnography monitoring during conscious sedation. In the podcast, Drs. Kurrek and Merchant discuss why capnography monitoring may have been considered yesterday’s luxury, but is now a necessity during conscious sedation.

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Opioid Safety, Respiratory Compromise

Capnography The Ventilation Vital Sign

Editor’s Note: This research was presented as a poster at the 2017 ANCC National Magnet Conference.

By Eric Griffin MSN, RN, CEN (Magnet Program Director, Baystate Medical Center) and Laura Bolella MSN, RN (Assistant Nurse Manager, Baystate Medical Center)

For over a hundred years nurses have monitored the same vital signs. Unfortunately these vital signs can be slow to change, inaccurate, and misleading. Although there have been modern advances in physiological monitoring devices, their acceptance has been limited. Pulse oximetry developed in the early 1970’s is extremely useful in measuring oxygenation, although it has limitations related to the following factors: poor signal strength, fingernail polish, anemia, patient motion, calloused skin, hypoperfusion, time lag, and vasoconstriction.

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Opioid Safety, Respiratory Compromise

Opioids Can Cause Adverse Events and Patient Deaths: ECRI Institute Patient Safety Organization’s Deep Dive Analysis Three Clinical Education Podcasts on Preventing Opioid-Related Harms

Despite the focus on appropriate use of opioids for pain management, ECRI Institute Patient Safety Organization (PSO) found that there are many hospitals that continue to experience opioid-related adverse events. To help prevent further patient harms and deaths, PSO conducted a deep dive analysis of adverse events related to opioids in the acute care setting.

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Opioid Safety, Respiratory Compromise

Standards for Dental Anesthesia Should Require Patient Monitoring An Update and Commentary on 5-Year Old Amber Athwal who Suffered Brain Damage Following Teeth Extraction

Five-year old Amber Athwal suffered brain damage after having dental surgery to extract some of her teeth. For our earlier post, which provides a summary of the lawsuit , “Capnography Monitoring of Five-Year Old Amber Athwal May Have Prevented Her Brain Damage,” please click here.

Dr. William Mather Tribunal Hearing

CBC News reports that Dr. William Mather, the dentist who performed the dental procedure which resulted in “permanent brain damage because of oxygen deprivation”, faces five counts of unprofessional conduct, and has pleaded guilty to three of the charges. Dr. Mather recently retired from dental practice.

Dr. Mather’s colleague, Dr. Darren Fee recently testified at the tribunal hearing investigating the Amber case:

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Opioid Safety, Respiratory Compromise

7 Must Reads for Beating the Opioid Epidemic Don't Just Talk, Do Something About this Problem

This week even the White House took notice of the opioid epidemic, declaring opioid abuse a national public health emergency. However, the opioid epidemic was recognized as early as the 1990s, when doctors became increasingly aware of the burdens of pain.

But, saying there is a problem – the opioid epidemic which has long been recognized – and doing something about it, are two completely different things.

To help do something about it, we offer 7 must reads for beating the opioid epidemic:

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Opioid Safety, Respiratory Compromise

Continuous Patient Monitoring Provides Early Detection of Respiratory Compromise Physician-Patient Alliance for Health & Safety Clinical Education Podcast with Dr. Jeffrey Vender

In a clinical education podcast produced by the Physician-Physician Alliance for Health Safety, Jeffrey S. Vender, MD. cautions that otherwise stable patients can quickly move down the dangerous path to respiratory compromise:

“There are numerous situations where patients with underlying pulmonary disease are in very chronic, but stable conditions. And, for a multitude of reasons, either a therapeutic intervention, the administration of pharmaceutical agents, in particular sedative agents and/or narcotics, as you’ve alluded to, or an underlying disease, like pneumonia, can make this stable respiratory condition and move it down the spectrum of patho-physiologic deterioration into respiratory compromise.”

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Opioid Safety, Respiratory Compromise

Correction – Podcast Interview with Dr. Jeffery Vender Is Respiratory Compromise The New “Sepsis”?: The Benefits of Early Detection Through Continuous Patient Monitoring

The full podcast can now be viewed at https://youtu.be/xmOpSZaBi1w.

We had tried to have YouTube correct the previously upload which only played the first 4 minutes of the 18 minute interview, but they were unable to do that and so we have been forced to re-upload the podcast.

We apologize again for any inconvenience that this may have caused you.

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Opioid Safety, Respiratory Compromise

Why Have Low Safety Standards for Dental Anesthesia? The idea that dental anesthesia is somehow different than anesthesia for any other type of procedure isn't true.

In their article, “Why Have Low Safety Standards for Dental Anesthesia?,” Annie Kaplan, MD, Michael Wong, JD, and Patricia Salber, MD, MBA provide an update on the effort to pass Caleb’s Law.

The law was modified during the legislative process, signed into law and became effective in California as of January 1, 2017. It provided for collection of  adverse event data, instituted a disclosure that anesthesia in dentistry is practiced differently than in medicine, and asked that the California dental board do a study on the safety for children undergoing anesthesia in dentistry and make recommendations to improve safety. Read More

Opioid Safety, Patient Safety, Practices & Tips, Respiratory Compromise

Clinical Tip – Avoiding Opioid-Related Respiratory Depression Continuous electronic monitoring tops pulse oximetry or spot checks

At certain dosages, the opioids you give to patients to manage surgical pain can lead to respiratory depression — and overdoses can lead to respiratory failure.

#opioid overdoses can lead to respiratory failure, insufficiency, and arrest #patientsafety Click To Tweet

In this article published in Outpatient Surgery, Michael Wong, JD (Founder and Executive Director, Physician-Patient Alliance for Health & Safety) discusses why pulse oximetry and nursing spot checks are not enough to prevent respiratory depression and keep patients safe.

PPAHS Statement on Continuous Electronic Monitoring

PPAHS Statement on Continuous Electronic Monitoring

Don't rely on pulse oximetry and nursing spot checks to ensure #patientsafety Click To Tweet

To read the PPAHS Statement on Continuous Monitoring, please click here.

To read the article in Outpatient Surgery, please click here.

Opioid Safety, Patient Safety, Respiratory Compromise

Was the Death of Erik Nelson of Preventable?

By Michael Wong, JD (Founder and Executive Director, Physician-Patient Alliance for Health & Safety)

According to the Bozeman Daily Chroncle’s article, “Wrongful death lawsuit filed against Bozeman surgeon,” Erik Nelson underwent surgery to correct his chronic nasal obstruction and severe obstructive sleep apnea. Discharged the day after surgery, Mr, Nelson was sent home with a prescription of Oxycodone to manage his pain. Oxycodone is a semisynthetic opioid, which is prescribed for moderate to severe pain.

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