Opioid Safety, Respiratory Compromise

Was Gary Bougie’s Post-op Gallbladder Surgery Death Preventable?

Fox 9 News recently reported on the death of Gary Bougie following routine gall bladder surgery:

Gary Bougie was two months shy of his 36th birthday when he died nearly two years ago. His family suspects he died from a condition called opioid-induced respiratory depression after going to the hospital for gallbladder surgery and they want to warn other families about how to possibly avoid a tragedy like this

Bougie had just opened his new restaurant when he went to United Hospital for surgery to remove his gallbladder back in April of 2014. He stayed overnight for observation, but his parents say learning the next morning he’d passed away from complications during the night was surreal.

While the medical examiner ruled there was no anatomical cause for Bougie’s death, his family believes the mix of pain meds he was on caused him to fall into such a deep sleep, he stopped breathing. They are suing the hospital. Their attorney says even though nurses checked on Bougie once an hour, they should have used a fingertip sensor that would have alerted them when the level of oxygen in his blood went too low. Read More

Opioid Safety, Respiratory Compromise

Failure to Effectively Monitor Postoperative Patients May Lead to Brain Injury or Death

ECRI Institute recently released its report, “Top Ten Technology Hazards for 2016”, which noted that failure to effectively monitor postoperative patients for opioid-induced respiratory depression can lead to brain injury or death.

This concern of ECRI is yet another call for improved safety measures for patient’s receiving opioids.

Read More

Opioid Safety, Respiratory Compromise

On the Fifth Death Anniversary of Amanda Abbiehl, Physician-Patient Alliance for Health & Safety Calls for Continuous Monitoring of Patients Receiving Opioids

To honor the life of Amanda Abbiehl, who died after being connected to a patient-controlled analgesia (PCA) pump on July 17, the Physician-Patient Alliance for Health & Safety (PPAHS) calls for continuous electronic monitoring with pulse oximetry for oxygenation and with capnography for adequacy of ventilation. Read More

Opioid Safety, Respiratory Compromise

Top 10 Opioid Safety Articles in 2014

Of the more than 125 articles we posted in 2014, below are 10 of the most read and most discussed articles on opioid safety (order is by publication date).

As you read through these articles, please ask yourself – has a new standard of care been established requiring continuous electronic monitoring by hospitals of all patients receiving opioids? Read More

Alarm Fatigue, Must Reads, Opioid Safety, Respiratory Compromise

Weekly Must Reads in Patient Safety (Oct 17, 2014)

Monitoring is the catch word for this week’s must reads. It keeps patients safe and prevents avoidable patient harm. While St Joseph/Candler Hospital just celebrated 10 years of being “event free”, each year an estimated 20,800 to 678,000 patients managing their pain with patient-controlled analgesia will experience life-threatening, opioid-induced respiratory depression. If you are scared about asking your caregivers about monitoring, just say Dr. Robert Stoelting (President, Anesthesia Patient Safety Foundation) told you to. Read More

Opioid Safety, Respiratory Compromise

Open Letter for Patient Safety and Use of Continuous Electronic Monitoring

In the story, “Hypoxia After Surgery Much More Common Than Previously Believed — Study finds high rate of prolonged bouts of desaturation on wards” (Anesthesiology News, March), Daniel Sessler, MD (Michael Cudahy Professor & Chair, Department of Outcomes Research, The Cleveland Clinic; Director, Outcomes Research Consortium) who helped conduct the study, described its results as “sobering.” Read More

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.” Read More

Opioid Safety, Patient Stories, Respiratory Compromise

Woman’s Death After Knee Surgery Calls Attention to Need for Better Monitoring

by Sean Power

The recent death of Helen Bousquet after what is being described by her son, Brian Evans, as “a basic routine procedure” at a hospital 40 minutes north of Boston highlights the need for better monitoring of patients after surgery. Mr. Evans is accusing the hospital of criminal negligence, according to an exclusive interview with Valley Patriot, as a result of how his mother’s visit to the hospital was handled by staff. Read More

Alarm Fatigue, Opioid Safety, Patient Stories, Respiratory Compromise

Adverse Drug Events Discussed at California Hospital Engagement Network

by Sean Power

The Physician-Patient Alliance for Health & Safety recently participated in a webinar hosted through the California Hospital Engagement Network, an organization that brings together hospitals to reduce patient harm by 40% and readmissions by 20% by the end of 2013.

The panel discussion looked at patient stories and best practices for preventing opioid related adverse events. The panelists included: Read More

Opioid Safety, Respiratory Compromise

Reducing Errors by More than 60 Percent: PPAHS Presents at the Northern Regional Respiratory Care Conference

by Sean Power

Last week, the Physician-Patient Alliance for Health & Safety presented two cases in which health care facilities reduced PCA-related adverse drug events with continuous electronic monitoring.

Experts estimate that anywhere from 600,000 to 2,000,000 PCA errors occur each year. As Dr. Richard Dutton, Executive Director of the Anesthesia Quality Institute, states, “PCA errors certainly occur, both in programming and in delivery, but any published estimate is likely to be only the tip of the iceberg.” Read More