Opioid Safety, Respiratory Compromise

Tools and Recommendations for Assessing the Risk of Over-Sedation and Respiratory Depression

Although there are benefits to the use of opioids for the management of pain, particularly with patients post-operatively, there are risks of over-sedation and respiratory depression, as The Joint Commission cautions in its Sentinel Event Alert “Safe use of opioids in hospitals”:

While opioid use is generally safe for most patients, opioid analgesics may be associated with adverse effects, the most serious effect being respiratory depression, which is generally preceded by sedation.

Assessing which patients are at risk of developing opioid-induced respiratory depression (OIRD) would be of benefit, as treatments could be altered or tailored to the particular patient to reduce the risk of opioid-related adverse events.

The Michigan Opioid Safety Score (MOSS) was “developed to incorporate patient risk, respiratory rate, and sedation into one bedside score that could be used to improve patient safety during inpatient opioid therapy. Scoring is based on a summation of risk data with objective bedside measures of over-sedation trumping a patient’s subjective reports of pain.” Read More

Alarm Fatigue, Respiratory Compromise

The Risk of Opioids in Post-Surgical Settings

This is the fourth article in a series exploring the impact of pulse oximetry alarm thresholds in hospitalized patients.

By J. Paul Curry, MD (anesthesiologist)

In the first article, “Improving the Safety of Post-Surgical Care,” I introduced the concept that, although the current approach to physiologic threshold monitoring (triggering an alarm when oxygen saturation falls below 90%) works well in the OR, it is unreliable on post-surgical floors. Read More

Respiratory Compromise

Detecting Deadly Post-Surgical Respiratory Dysfunction

It is crucial to understand this type of respiratory dysfunction so that it can be detected and the patient is treated as early as possible in order to save lives.

By J. Paul Curry, MD (anesthesiologist)

This is the third article in a series exploring the impact of pulse oximetry alarm thresholds in hospitalized patients. In the first article, Improving the Safety of Post-Surgical Care,” I introduced the concept that, although the current approach to physiologic threshold monitoring (triggering an alarm when oxygen saturation falls below 90%) works well in the OR, it is unreliable on post-surgical floors. Read More

Alarm Fatigue, Respiratory Compromise

Pulse Oximetry False Alarms on Post-Surgical Floors

Adjusting pulse oximetry alarm thresholds to avoid false alarms and universally monitoring all triggered alarms improves patient safety—so why don’t we do it?

By J. Paul Curry, MD (anesthesiologist)

This is the second article in a series exploring the impact of pulse oximetry alarm thresholds in hospitalized patients. In the first article, “Improving the Safety of Post-Surgical Care,” I introduced the concept that, although the current approach to physiologic threshold monitoring (triggering an alarm when oxygen saturation falls below 90%) works great in the OR, it is unreliable on post-surgical floors. Read More

Respiratory Compromise

Improving the Safety of Post-Surgical Care

Although physiologic threshold monitoring works great in the OR, it is unreliable on post-surgical floors

By J. Paul Curry, MD (anesthesiologist)

Up to 750,000 cardiopulmonary arrests occur in hospitals every year in the United States. According to a review in Intensive Care Medicine, only 15 to 20 percent of these patients will survive.

Tragically, the survival rate following in-hospital cardiopulmonary resuscitation has changed little in the last 40 years, even though much has been done to improve respiratory monitoring and the deployment of competent resuscitation. One study of 139 in-hospital deaths showed that 62 percent could have been prevented if deterioration had been detected earlier, and nearly half (48 percent) of these patients had clear clinical signs of deterioration that went unnoticed. Read More