Opioid Safety, Respiratory Compromise

Patients Need to Be Better Assessed for Respiratory Compromise

Editor’s Note: What might better assessment for respiratory compromise mean to a patient’s outcome? We ask this question in light of yesterday’s post on an assessment tool and the death of 17-year old Logan.

Yesterday, we posted on research by Hiroshi Morimatsu, M.D.,Ph.D (Okayama University Hospital, Okayama, Japan) and his colleagues on whether a patient pulmonary index could be a predictor of respiratory adverse events.

On July 23, 2007, 17-year old Logan died after successfully undergoing routine surgery to correct his sleep apnea.

Logan

Click on the image of 17-year old Logan to hear his mother, Pamela Parker, BSN, RN, CAPA discuss his death and lessons she has learned from it.

If Logan had been assessed for the risk of respiratory compromise, would he still be alive today?

Below are some key excerpts from the interview with Ms. Parker on what was done to assess Logan for respiratory compromise:

Logan received IV morphine. Two milligrams administered at 12:50, again at 12:53, and again at 13:10. His IV was removed eight minutes later and he was discharged at 13:25, just fifteen minutes after his last dose of morphine

There was not any scoring tool used to track his level of sedation during his recovery period. The surgery center only used the Alrdete Score during his anesthesia recovery period. And in reality Logan died in 2007 prior to the common use of the Pasero Opioid Induced Sedation Scale

Based upon the [Pasero Opioid Induced Sedation] Scale Logan was probably a three. Changing the probe from one finger to another, it might have stopped the pulse oximeter alarm from going off, but it did not address the true problem. It can now be assumed that Logan was already having ventilation issues. According to that to the Pasero Opioid Induced Sedation Scale, Logan’s condition was unacceptable and this required a decreased opiate opioid dose – 25 to 50 percent – or notify the prescriber.

To listen to the complete interview with Ms. Parker on YouTube, please click here.

Tools that might help assess patients:

What risk assessment tools developed or being developed that would help assess patients for the risk of respiratory compromise?

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