Opioid Safety, Respiratory Compromise

5 Facts that Makes Patients with Obstructive Sleep Apnea More At-Risk for Death Research shows respiratory compromise may occur with obstructive sleep apnea patients receiving opioids

Researchers have found that respiratory compromise may occur with obstructive sleep apnea (OSA) patients receiving opioids.

Research conducted by Yamini Subramani, MD et al, “Death or near-death in patients with obstructive sleep apnoea: a compendium of case reports of critical complications” found 5 reasons why the risk of death is higher in patients with obstructive sleep apnea (OSA).

After removing for duplicates, the researchers analyzed more than 1,000 patient cases.

# 1 Fact – Patients can have obstructive sleep apnea and not know it

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Must Reads, Patient Safety

Patient Safety Weekly Must Reads (October 21, 2016)

This week in patient safety news, we featured a guest post article on pre-op screening and assessment for OSA.  We also found some great articles addressing the ICU, the opioid crisis, and the latest in wearable monitor studies. Read More

Respiratory Compromise

New Guideline on Pre-Op Screening and Assessment for OSA

This article was first published in Patient Safety Solutions on October 11, 2016.  As part of our efforts to bring in expert viewpoints from across the #patientsafety community, we have reposted this with permission.

By Bradley T. Traux, MD

Our regular readers are well aware of the numerous controversies and limited evidence base regarding perioperative issues in patients with known obstructive sleep apnea (OSA) or those suspected as being at high risk for OSA (see the list of prior columns at the end of today’s column).

The Society of Anesthesia and Sleep Medicine has just published “Guidelines on Preoperative Screening and Assessment of Adult Patients with Obstructive Sleep Apnea”. This is a most thorough evaluation of the evidence base regarding multiple issues related to OSA in patients about to undergo surgery. One is struck by the lack of strong evidence for almost all the recommendations in the guideline, though we are not surprised since we’ve previously discussed most of the controversial issues. Yet this consensus guideline uses common sense and is very practical and appropriately balances concerns for patient safety with utilization of resources and concerns over timing of surgery.

Below is their executive summary of the recommendations: Read More

Opioid Safety, Respiratory Compromise

3 Keys To Successfully Implementing Capnography

As a follow-up to our latest podcast interview with Thomas W. Frederickson, MD, FACP, SFHM, MBA – lead author of the Society of Hospital Medicine RADEO guide (“Reducing Adverse Drug Events Related to Opioids”) – we focused on the advantages and limitations of pulse oximetry in monitoring patients for opioid-induced respiratory depression.

Most importantly, Dr. Frederickson highlighted that the alerts provided by pulse oximetry can be a lagging indicator of patient ventilation, particularly when supplemental oxygen is administered.  One solution to improving the care provided to patients is to understand that pulse oximetry is one part of a comprehensive monitoring strategy. Read More

Alarm Fatigue, Opioid Safety

3 Limitations to the Use of Pulse Oximetry

Image source: http://thedoctorweighsin.com/pulse-oximetry-false-alarms-on-post-surgical-floors/

Image source.

In PPAHS’ latest podcast, we spoke with Thomas W. Frederickson, MD, FACP, SFHM, MBA – lead author of the Society of Hospital Medicine RADEO guide (“Reducing Adverse Drug Events Related to Opioids”).  The RADEO guide is a comprehensive clinician manual created with the aim to decrease opioid-related adverse events in an inpatient setting. Read More

Respiratory Compromise

5 Strategies to Keep Patients Safe When Receiving Opioids

The Physician-Patient Alliance for Health & Safety (PPAHS) had the pleasure of interviewing Thomas W. Frederickson, MD, FACP, SFHM, MBA – lead author of the Society of Hospital Medicine RADEO guide (“Reducing Adverse Drug Events Related to Opioids”).  The guide is a comprehensive clinician manual created with the aim to decrease opioid-related adverse events in an inpatient setting.

In the first of this two-part interview, Dr. Frederickson discusses five key steps to identify and address patient conditions that pose a greater risk of respiratory depression.  For readers that have yet to listen to the podcast, please click here; it’s an insightful interview relevant for any clinician working in quality improvement or directly with patients prescribed opioids.

In part two, interviewer Pat Iyer and Dr. Frederickson switches gears and focuses on monitoring issues associated with caring for at-risk patients.  You can watch/listen to the interview below: Read More

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

5 Key Resources to Reduce the Risk of Respiratory Compromise with Patients with Sleep Apnea

In a recent interview with a spotlight on the RADEO guide, Dr. Thomas Frederickson, MD, FACP, SFHM, MBA highlighted obstructive sleep apnea (OSA) as a key contributing condition to greater opioid use risk.

“Sleep apnea is the number one risk factor for respiratory depression associated with the use of opioids.

[…] Patients with obstructive sleep apnea are dependent upon their arousal mechanism in order to avoid respiratory depression and eventual respiratory failure.”

In addition to being the #1 contributing risk to opioid-induced respiratory depression, OSA is also common and often under diagnosed.  Dr. Frederickson states that between 7% and 22% of the adult population has a degree of sleep apnea.

The key question that arises, then, is how to better identify and account for OSA in patients receiving opioids?  Here are 5 key resources to reduce the risk of respiratory compromise in this group. Read More