Opioid Safety, Patient Safety, Respiratory Compromise

3 Recommendations to Implement to Improve Patient Safety During Sedation PPAHS Wishes You a Safe and Happy New Year!

The Physician-Patient Alliance for Health & Safety wishes you a safe and Happy New Year!

To help make 2019 patient safe, please implement the following 3 recommendations to keep your patients safe:

Patients Receiving Opioids Must Be Monitored With Continuous Electronic Monitoring

Much of the public attention has been focused on the harm caused by prescription use and abuse of opioids. However, there is another facet that must be focused on: opioid-induced respiratory depression in clinical settings. This includes patients undergoing moderate and conscious sedation, or recovering from procedures and managing pain using a patient-controlled analgesia (PCA) pump, particularly those during the postoperative period.

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

All patients receiving #opioids in-hospital should be monitored Click To Tweet

Position Statement on Concomitant Use of Benzodiazepines and Opioids

One of the commonly overlooked complications to safe opioid administration is failing to account for the additive sedation effects of non-opioid medication. In recognition of these dangers, in August 2016, the FDA issued its strongest warning about combined use of opioids and benzodiazepines and issued another caution more recently on September 20, 2017.

To further emphasize that the concomitant use of benzodiazepines and opioids may be a deadly combination, the Physician-Patient Alliance for Health & Safety released a position statement, “Patients Receiving Benzodiazepines, in Combination with Opioid Analgesics, May Suffer from Respiratory Compromise and Death.”

To read the PPAHS Position Statement on Concomitant Use of Benzodiazepines and Opioids, please click here.

Concomitant Use of #Benzodiazepines and #Opioids is Not #patientsafe Click To Tweet

Position Statement on Procedural Sedation

Although procedural sedation is generally safe, the Physician-Patient Alliance for Health & Safety recommends that all procedural sedation follow at least these five precautions:

  1. Administration of Procedural Sedation Must Be With Trained Personnel, Who SHOULD NOT Also Be Performing the Procedure
  2. Equipment and Supplies Must Be On-Hand in Case of Oversedation and Respiratory Compromise – and Clinicians Need to Practice How to Use Them!
  3. Early Detection of Respiratory Compromise Will Decrease Adverse Events and Patient Deaths
  4. All Patients Undergoing Procedural Sedation Should be Monitored with Capnography
  5. Recovery and Discharge of the Patient Must be Supervised by Trained Anesthesia Providers

To read the Position Statement on Procedural Sedation, please click here.

All procedural #sedation follow at least these five precautions Click To Tweet
Opioid Safety, Respiratory Compromise

Capnography Monitoring During Conscious Sedation: Essential for Maintaining "Eyes and Ears" on Patients

The Physician-Physician Alliance for Health Safety has released a clinical education podcast on capnography monitoring during conscious sedation with Barbara McArthur, RN, BScN, CPN(C). Ms. McArthur is an advanced practice nurse at Sunnybrook Health Sciences Centre in Toronto, Canada.

Capnography Monitoring: An Early Indicator of Patient Deterioration

After reviewing the current literature, Sunnybrook decided that monitoring with capnography resulted in safer patient care. Capnography monitoring provides an early indicator of patient deterioration, which can be crucial in averting adverse events and patient deaths. Capnography monitoring, says Ms. McArthur, is monitoring in “real time. With pulse oximetry, there is a delay, which could be up to a minute in healthy patients. So, that’s a significant sort of time that is delayed that reaction could happen.” 

 

#Capnography Monitoring Provides An Early Indicator of Patient Deterioration Click To Tweet                Read More

Opioid Safety, Respiratory Compromise

5 Keys to Safer Hospital Sedation

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

Conscious sedation is routinely used with patients so that they can tolerate procedures that may cause them discomfort, anxiety, or pain. Some of the tests and procedures conscious sedation may be used for are:

  • Breast biopsy
  • Dental prosthetic or reconstructive surgery
  • Minor bone fracture repair
  • Minor foot surgery
  • Minor skin surgery
  • Plastic or reconstructive surgery
  • Procedures to diagnose and treat some stomach (upper endoscopy), colon (colonoscopy), lung (bronchoscopy), and bladder (cystoscopy) conditions.

Conscious sedation may also be used with pediatric patients or adult patients who may have difficulty remaining still for certain tests and medical procedures. Read More

Opioid Safety, Patient Stories, Respiratory Compromise

Sedation and cataract surgery: A case for continuous electronic monitoring

By Michael Wong

“Inexplicably left alone.”

That, according to Jury Verdict Review & Analysis, is what happened to 68-year-old Marie Golubski after she was prepped and intravenously sedated for cataract surgery in June 2010. In other words, no anesthesiologist, no nurse or no ophthalmologist was present when Ms. Golubski slipped into respiratory depression. Read More