Must Reads, Opioid Safety, Respiratory Compromise

Weekly Must Reads in Patient Safety and Health Care (November 13, 2015) – We Need Better Pain Management

Could the rising death rate of middle-aged white Americans be due to inadequate pain management and education?

Two Princeton University economists – Drs. Angus Deaton and Anne Case, who last month won the 2015 Nobel Memorial Prize in Economic Science – analyzed health and mortality data from the Centers for Disease Control and Prevention and from other sources.

Deaths per 100,000: http://www.vox.com/2015/11/7/9684928/angus-deaton-white-mortality

Deaths per 100,000: http://www.vox.com/2015/11/7/9684928/angus-deaton-white-mortality

Reports the NY Times:

The analysis by Dr. Deaton and Dr. Case may offer the most rigorous evidence to date of both the causes and implications of a development that has been puzzling demographers in recent years: the declining health and fortunes of poorly educated American whites. In middle age, they are dying at such a high rate that they are increasing the death rate for the entire group of middle-aged white Americans, Dr. Deaton and Dr. Case found.

Thanks @RogerAjogbe, @MarcVegan, and many others for their tweets about the research by Dr. Deaton and Dr. Case.

In an interview with Dr. Deaton, he noted “data showing an uptick in reliance on opioid painkillers — an epidemic that started in the late 1990s that has been linked with terrible health and mortality outcomes.”

So, what can be done to improve this situation?

ECRI Recommendations

Failure to effectively monitor postoperative patients for opioid-induced respiratory depression again made ECRI Institute’s 2016 Technology Hazards List. ECRI recommends implementing the recommendations of the Anesthesia Patient Safety Foundation (APSF) and The Joint Commission:

Hospitalized patients receiving postoperative opioids—such as morphine, hydromorphone, or fentanylare at risk for drug-induced respiratory depression, which can lead to anoxic brain injury or death.

Even if they are otherwise healthy, such patients can be at risk if, for example:

  • They are receiving another drug that also has a sedating effect.
  • They have diagnosed or undiagnosed comorbidities that predispose them to respiratory compromise, such as morbid obesity or sleep apnea.
  • A medication error results in delivery of more medication than intended—for example, an error is made when programming the dose or concentration on the infusion pump, or a bag or syringe of the wrong concentration or wrong medication is used.

 Intermittent spot checks of oxygenation and ventilation every few hours are inadequate for reliably detecting opioid induced respiratory depression.

To address this problem, a healthcare facility’s medical leadership should implement the relevant recommendations from the Anesthesia Patient Safety Foundation (APSF) and the Joint Commission.

 Hats off to those for their tweets about the ECRI report, including @nursesau, @ssfraser, and @CPCBernoulli.

Hospitalized #patients receiving #postoperative #opioids at risk for drug-induced respiratory depression @ECRI_Institute Click To Tweet

Better Opioid Education

Research presented in poster form during PAINWeek 2015 of a survey of 85 pain management specialists found that a “majority of members of the medical community admit that they haven’t received enough training on long-term opioids to properly manage chronic pain patients”:

Better Opioid Education: http://www.painmedicinenews.com/ViewArticle.aspx?ses=ogst&d=Multimedia&d_id=559&i=November+2015&i_id=1244&a_id=34180

Better Opioid Education: http://www.painmedicinenews.com/ViewArticle.aspx?ses=ogst&d=Multimedia&d_id=559&i=November+2015&i_id=1244&a_id=34180

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