Must Reads, Opioid Safety, Respiratory Compromise

Weekly Must Reads in Patient Safety (March 13, 2015)

Rethinking is the theme for this week. To improve health outcomes and improve patient safety, this week’s must reads ask us to rethink what we are doing.how are you rethinking #patientsafety? Click To Tweet

Rethinking Resources Needed for Most Critically Ill Patients

According to David A. Theodore, MD, FACS (Cardiac Surgeon and Chairman, Cardiovascular Dept., SSM Health Care, the top 5 percent of patients account for the majority of annual healthcare spend:

It’s this top 5 percent of patients who consume somewhere between 45 to 50 percent of the healthcare dollar on an annual basis that I have the biggest interest in the from the population health perspective. These 5 percent of patients are the most critically ill and represent the largest cohort of patients with care variability and care gaps compared to the other cohorts.

In a roundtable discussion involving major healthcare organizations like The National Association for Medical Direction of Respiratory Care (NAMDRC), American Association for Respiratory Care (AARC), American Association of Critical Care Nurses (AACN), and the Physician-Patient Alliance for Health & Safety, the importance of early identification of when a patient may be suffering from respiratory compromise was discussed.

Rethinking What is Standard

A recent study involving more than 1,000 patients who were due to be operated on under general anesthetic calls into question the routine prescribing of sedatives prior to surgery:

It is a widespread practice to give patients sedatives before a surgical intervention, because of their anti-anxiety effects. The most commonly prescribed drugs in these cases are benzodiazepines like lorazepam, diazepam or midazolam. Nevertheless, these drugs have side-effects like insomnia, weariness, dizziness or cognitive impairment. The improvement they bring might be smaller than the discomfort they cause.

A new study conducted by researchers at the Hôpital de la Timone Adulte in Marseille, France, whose results are published in the Journal of the American Medical Association, indicates that, at least in the case of lorazepam, sedating patients does not improve their satisfaction with the surgical procedure.

Rethinking Opioid Dosing

Researchers have found a minimal decline in opioid dosing:

Despite years of concern about the need for lower opioid dose limits, opioid dosing fell only minimally in the six-year period from 2008 to 2013. What’s more, concurrent benzodiazepine therapy was associated with higher opioid dosing, although a lower opioid dose is recommended when combining the two classes.

Rethinking How to Achieve Excellence in Opioid Safety

Hats off to @gochujang81, @jazziz65, @GxP_Services, and many others, who tweeted about our featured presentation at the recent the AORN Surgical Conference & Expo.

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