The Physician-Patient Alliance for Health & Safety today issued the following statement encouraging the continuous electronic monitoring of all patients receiving opioids:
To improve patient safety and save patients’ lives, we recommend adopting continuous respiratory monitoring of all patients receiving opioids with pulse oximetry for oxygenation and with capnography for adequacy of ventilation to improve timely recognition of respiratory depression, decompensation or clinical deterioration.
The Centers for Medicare & Medicaid Services (CMS) issued on March 14, 2014 revised guidance, “Requirements for Hospital Medication Administration, Particularly Intravenous (IV) Medications and Post-Operative Care of Patients Receiving IV Opioids”.
The CMS guidance recommends “at a minimum” that hospitals “have adequate provisions for immediate post-operative care, to emphasize the need for post-operative monitoring of patients receiving IV opioid medications, regardless of where they are in the hospital.”
In addition and more importantly, the CMS guidance necessitates monitoring for all patients receiving opioids when in hospital:
Narcotic medications, such as opioids, are often used to control pain but also have a sedating effect. Patients can become overly sedated and suffer respiratory depression or arrest, which can be fatal. Timely assessment and appropriate monitoring is essential in all hospital settings in which opioids are administered, to permit intervention to counteract respiratory depression should it occur.
“In issuing this statement,” explains Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety), “we are especially reminded of Amanda Abbiehl, Leah Coufal, John LaChance, and countless others who may still be alive today had they been continuous electronically monitored.”
Physician-Patient Alliance released these and other stories of patients who suffered opioid-induced respiratory depression at the inaugural meeting of the National Coalition to Promote Continuous Monitoring of Patients on Opioids. For a full copy of all of the stories shared with the meeting’s attendees, please click here.
The CMS guidance provides increased vigilance to patients receiving opioids, particularly those patients receiving opioids postoperatively. CMS explains the reason behind the issue for this guidance:
Each year, serious adverse events, including fatalities, associated with the use of IV opioid medications occur in hospitals. Opioid-induced respiratory depression has resulted in patient deaths that might have been prevented with appropriate risk assessment for adverse events as well as frequent monitoring of the patient’s respiration rate, oxygen and sedation levels. Hospital patients on IV opioids may be placed in units where vital signs and other monitoring typically is not performed as frequently as in post-anesthesia recovery or intensive care units, increasing the risk that patients may develop respiratory compromise that is not immediately recognized and treated.