Carla R Jungquist1, Darin J Correll, Lee A Fleisher, Jeffrey Gross, Rajnish Gupta, Chris Pasero, Robert Stoelting, Rosemary Polomano. 1. Author Affiliations: Assistant Professor (Dr Jungquist), School of Nursing, University at Buffalo, New York; Assistant Professor of Anaesthesia (Dr Correll), Harvard Medical School, Boston, Massachusetts; Professor and Chair (Dr Fleisher), Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia; Professor and Chairman (Dr Gross), Department of Anesthesiology, University of Connecticut School of Medicine, Farmington; Assistant Professor (Dr Gupta), Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee; Pain Management Clinical Consultant (Ms Pasero), El Dorado Hills, California; President (Dr Stoelting), Anesthesia Patient Safety Foundation, Indianapolis, Indiana; Professor of Pain Practice (Dr Polomano), University of Pennsylvania School of Nursing, Philadelphia.
Abstract
BACKGROUND: Guidelines with recommendations for monitoring type and timing of hospitalized patients for opioid-induced respiratory depression have been published, yet adverse events continue to occur. OBJECTIVE: This study reports on the monitoring practices of 8 hospitals that volunteered to pilot test a Centers for Medicare & Medicaid Services e-quality measure that was under development. Recommendations for nurse executives are provided to support patient safety. METHODS: Data on monitoring practices were collected retrospectively from the electronic medical records at 8 hospitals on all patients receiving intravenous (IV) opioids for more than 2.5 continuous hours via patient-controlled analgesia (PCA). Analysis included the percentage of patients who were monitored according to specific standards developed by a panel of technical experts with comparisons of naloxone use to monitoring practices. RESULTS: Recommended patient assessments occurred in only 8.3% of the patients. No patients who were assessed at least every 2.5 hours received naloxone. CONCLUSIONS: Care for patients receiving IV PCA is lacking in adherence to latest safety standards. Nurse executives must implement structures and processes to promote vigilance with evidence-based monitoring practices.
BACKGROUND: Guidelines with recommendations for monitoring type and timing of hospitalized patients for opioid-induced respiratory depression have been published, yet adverse events continue to occur. OBJECTIVE: This study reports on the monitoring practices of 8 hospitals that volunteered to pilot test a Centers for Medicare & Medicaid Services e-quality measure that was under development. Recommendations for nurse executives are provided to support patient safety. METHODS: Data on monitoring practices were collected retrospectively from the electronic medical records at 8 hospitals on all patients receiving intravenous (IV) opioids for more than 2.5 continuous hours via patient-controlled analgesia (PCA). Analysis included the percentage of patients who were monitored according to specific standards developed by a panel of technical experts with comparisons of naloxone use to monitoring practices. RESULTS: Recommended patient assessments occurred in only 8.3% of the patients. No patients who were assessed at least every 2.5 hours received naloxone. CONCLUSIONS: Care for patients receiving IV PCA is lacking in adherence to latest safety standards. Nurse executives must implement structures and processes to promote vigilance with evidence-based monitoring practices.