In a clinical education podcast, Frank Overdyk, MD, who is an anesthesiologist practicing in Charleston, SC, discusses preventing avoidable deaths and the costs of monitoring patients receiving opioids and the costs of not being monitored. It is impossible to predict with 100% accuracy how a particular patient will react when administered an opioid. Continuous patient monitoring, which costs just $20-$30 per day in the case of monitoring with pulse oximetry, is a small price to pay to help prevent avoidable patient deaths.
By Michael Wong, JD (Founder/Executive Director, Physician-Patient Alliance for Health & Safety)
I recently interviewed Frank Overdyk, MD, who is an anesthesiologist practicing in Charleston, SC, about the costs of monitoring patients receiving opioids and the costs of not being monitored. Dr. Overdyk is a member of board of advisors of the Physician-Patient Alliance for Health & Safety and organized the two conferences on opioid-induced respiratory depression (“OIRD”) for the Anesthesia Patient Safety Foundation.
Preventing Avoidable Deaths
Dr. Overdyk has devoted his career to reducing preventable harms to patients and, more particularly, to preventing OIRD:
During my career, I’ve been studying the pain medications – simply opioids on breathing. In my research, I became aware that there are thousand of the patient dying unnecessarily from too much opioid pain medicine. My passion is finding ways to reduce this preventable harm from patients who receive too much pain medicine and stop breathing, and eventually reduce that to zero.
Impossible to Predict How a Patient Will React to Opioid Administration
Dr. Overdyk discussed why it is impossible to predict with 100% accuracy how a particular patient will react when administered an opioid:
“what is not appreciated by patients and by some doctors and nurses is that a patient’s response to a “standard dose of morphine,” for instance, can vary up to 30 fold. And, what that means is if I give a hundred patients the same dose of morphine – ten milligrams of morphine – about ninety patients will get some level of pain relief – some better, some worse – and breath adequately, but there may be one or two patients who slow their breathing or even stop breathing. And, it is very difficult because of that variation in effect to predict which patients will be the one who stops breathing, when you turn your back on them for ten minutes. So, I always say there’s no safe first dose of opioids, there’s just a starting dose, and it is critically important that the patient be checked regularly to see how the patient responds and then adjust your doses accordingly.”
Consequently, Dr. Overdyk does not recommend using existing assessment tools to triage patients, as they are not 100% accurate:
“triaging patients implies that there is a group of patients who are not at risk and this is unfortunately false. We have plenty of examples of tragic cases of patients, who do not have any of these disease conditions I’ve mentioned or these physical attributes that put them at high risk. But, they died on a hospital ward typically behind a closed door from unrecognized opioid-induced respiratory depression. These are patients are healthy patients who come in for elective surgery and they’re typically opiate naive. So, no tool will be a 100% in successfully in identifying every patient …”
$20-$30 Are the Costs to Monitor a Patient Per Day
Unfortunately, triaging is often used to determine which patients are monitored and which are not, which is often done because of resource constraints. And, yet, the costs of monitoring has been estimated to be between $20 or $30 a day, says Dr. Overdyk:
The cost of technology is a moving target, since the cost has come down, as adoption becomes more widespread and there are different pricing models as well. You can price by disposables, so there are creative ways to finance that [continuous monitoring], but there are estimates that the daily cost of continuous monitoring of a patient for example with a pulse oximetry is on the order of 20 or 30 dollars a day. This does not include the cost implications of staff workflow and some of these other softer costs – indirect costs. Although rolling out new technology may initially require more resources, there are many institutions that have now adopted continuous monitoring where a couple of things have happened – the institution finds that it is to their financial benefit, the providers find it to their clinical benefit that they are vocal about removing the technology.
One example of a hospital that has successfully implemented continuous patient monitoring is St Joseph/Candler Hospitals in Savannah, GA. In this clinical education podcast, Harold Oglesby RRT, Manager, The Center for Pulmonary Health, Candler Hospital, St. Joseph’s/Candler Health System discusses SC/J’s 12 years of event free use of opioids:
This is a cost that Dr. Overdyk believes is justified for today’s hospitalized patients. As he says:
Ideally, I believe all hospitalized patients in 2018 deserve at a minimum some form up of continuous monitoring. Triaging is acceptable and it will catch those patients at the highest risk, but if we have a zero tolerance for preventable harm, then we should by paying for continuous monitoring of all patients.
I wholeheartedly agree! Do you?
For a transcript of the interview, please click here.
To listen to the interview, please click here.
This clinical education podcast is made possible by educational grants from Medtronic and EarlySense.