The Physician-Patient Alliance for Health & Safety (PPAHS) has released a YouTube video which discusses in nine minutes how to improve opioid safety. The video features highlights from over 10 hours of in-depth interviews released by PPAHS in 2016; altogether, the podcast series has generated over 130,000 cumulative views on YouTube. The podcast series brings together physicians, nurses, and respiratory therapists discussing how they have improved opioid safety in their hospitals.
According to Michael Wong, JD, Founder and Executive Director of PPAHS:
“In just nine minutes, the video summarizes experiences of clinicians in improving opioid safety in their hospital or healthcare facility, and reminds us of the tragic consequences of adverse events and deaths that may ensue if clinicians and healthcare executives are not proactive in promoting safety. We hope that the video will energize quality improvement and patient safety teams to strive to reduce adverse events and deaths related to opioid use.”
The opioid epidemic was one of the most heavily-covered, and hotly-debated, topic in patient safety covered in 2016. This dialogue has been mostly centered around the effects of ‘street’ use and abuse of prescription painkillers. In contrast, the PPAHS podcast series aims to highlight the preventable harm of opioid-induced respiratory depression during hospital procedures.
Says Michael Wong, Founder and Executive Director, PPAHS:
“Respiratory compromise increases patient mortality rates by over 30 percent and increases hospital and ICU stays by almost 50 percent.”
Opioid-related adverse events have a real impact on families
Cindy Abbiehl, Co-Founder of the Promise to Amanda Foundation, spoke about her daughter, Amanda’s story:
“We went in on a Thursday. Friday evening she was put on the pain pump and by Saturday morning she had passed away. She was our only daughter.
“Brian and I will never be able to see who she marries. I’ll never be able to pick a wedding dress out with her. We’ll never be able to have her father/daughter dance.”
Pamela Parker, BSN, RN, CAPA, also shared the heart-breaking story of her son, Logan:
“I pleaded with Logan to try harder and to hang on. I even promised to have him meet Peyton Manning, if he would just try harder. I rubbed his face and his arms. I told him how much I needed him, and that I needed him to try, to try very hard.”
Opioid harm can be prevented with the right culture, monitoring, and tools
Peggy Lange (RT, Director, Respiratory Care Department, St Cloud Hospital, MN) stressed that ingraining a culture of safety across all levels of the hospital is paramount:
“Narcotics and sedatives can cause respiratory depression, especially in a post-op period of time. I encourage all the caregivers to really think that they’re in intensive care environment for those first few hours until that patient recovers or starts waking up.”
Lynn Razzano, RN, MSN, ONCC, clinical nurse consultant, adds that nurses and nursing organizations must play a vital role in adopting monitoring standards that include capnography:
“More and more professional societies are issuing guidelines supporting the increased use of capnography for patient monitoring. In January ’15, the Association of periOperative Registered Nurses (AORN) released a moderate sedation guideline update saying that perioperative nurse should monitor exhaled CO2, end-tidal CO2, by capnography in addition to SP02 by pulse oximetry during moderate sedation analgesia procedures. This was also identified in January 2015 by the Association for Radiologic and Imaging Nursing stating that it endorses the routine use of capnography for all patients who receive moderate sedation analgesia during procedures in the imaging environment”
Richard Kenney, MSM, RRT, NPS, ACCS, RCP, Director, Respiratory Care Services, White Memorial Medical Center, implemented a monitoring program combining pulse oximetry and capnography to detect the early signs of opioid-induced respiratory depression:
“Since the implementation of this combination of monitoring the patient, the number of rapid responses to those areas where the patient comes out with that PCA pump have – I want to say – a better than fifty percent reduction in calls of rapid responses.”
Thomas W. Frederickson MD, FACP, SFHM, MBA, lead author of Society of Hospital Medicine’s RADEO Guide (Reducing Adverse Drug Events Related to Opioids):
“[A] QI approach that involves policies, that involves making it easy for clinicians to do the right thing through appropriate tools and interventions, is so important in this realm; because the medicine and the patients can be complicated and clinicians need to have it easy for them to make good decisions and to treat their patients in a way that is going to be effective but safe.”
Clinicians need to adopt a proactive response to opioid safety
Says Harold Oglesby RRT, Manager, The Center for Pulmonary Health, Candler Hospital, St. Joseph’s/Candler Health System:
“Don’t wait for a patient death or an adverse event to occur to be proactive, and implement some type of continuous monitoring for your patients before you get behind the eight ball and you have a bad outcome.”
Eyal Zimlichman, M.D., MSc, Deputy Director General and Chief Quality Officer, Sheba Medical Center shared his thoughts on the future of opioid safety:
“It’s my notion that maybe ten years from now, we’ll be seeing continuous monitoring on every bed in the hospital. It’s industry’s responsibility and ours as researchers to find the right technology to the right setting.”
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