Could better communications improve handoffs and opioid management? This week’s must read articles say “yes!”. ” Continue reading “Weekly Must Reads in Patient Safety and Health Care (October 9, 2015) – Better Hand-Offs & Opioid Management”
Tag: opioid pain management
Improving Health Care to Prevent Adverse Events and Death: Physician-Patient Alliance for Health & Safety Announces Educational Series on Continuous Patient Monitoring
To help improve health care by preventing adverse events and death, the Physician-Patient Alliance for Health & Safety (PPAHS) is hosting an educational series on continuous patient monitoring.
“This clinical education series will feature doctors, nurses and respiratory therapists discussing how they have successfully implemented continuous patient monitoring in their hospitals,” said Michael Wong, JD (Executive Director, PPAHS). “The series will also address how these hospitals and clinicians were able to overcome challenges to implementing monitoring.” Continue reading “Improving Health Care to Prevent Adverse Events and Death: Physician-Patient Alliance for Health & Safety Announces Educational Series on Continuous Patient Monitoring”
5 Keys to Successful Monitoring of Patients Receiving Opioids (Patient Safety & Healthcare Newsletter: – Harold Oglesby, RRT Discusses More Than 10 “Event Free” Years of Patient Safety)
5 Keys to Successful Monitoring of Patients Receiving Opioids
We wanted to know what are the keys to successful patient monitoring.
We could think of no better person to speak with than Harold Oglesby, RRT, Manager, The Center for Pulmonary Health, Candler Hospital, St. Joseph’s/Candler Health System (SJ/C). Since June 2004, SJC has been more than 10 “event free” years of patient safety. Continue reading “5 Keys to Successful Monitoring of Patients Receiving Opioids (Patient Safety & Healthcare Newsletter: – Harold Oglesby, RRT Discusses More Than 10 “Event Free” Years of Patient Safety)”
Wisdom Teeth Extraction and Patient Death: 17 Year-Old Sydney Galleger
by Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety)
According to the American Dental Association, each year about five million people have ten million wisdom teeth extracted in the United States. Usually administered under a local anesthetic and sometimes under a general anesthetic, teeth extraction is generally considered routine and simple. Continue reading “Wisdom Teeth Extraction and Patient Death: 17 Year-Old Sydney Galleger”
When Can Sleep Be Deadly?
We all know intuitively the benefits of sleep. As the Division of Sleep Medicine at Harvard Medical School says:
It may seem obvious that sleep is beneficial. Even without fully grasping what sleep does for us, we know that going without sleep for too long makes us feel terrible, and that getting a good night’s sleep can make us feel ready to take on the world. Continue reading “When Can Sleep Be Deadly?”
Protecting Post-Operative Obese Patients
This post originally appeared on Advance for Nurses. As that publication winds down, we have archived it here.
Nurses should be vigilant against obstructive sleep apnea
By Maureen F. Cooney, DNP, FNP-BC and Denise Sullivan, MSN, ANP-BC
Posted on: April 29, 2015
One in three U.S. adults (34.9% or 78.6 million) are obese, and from a health perspective, the odds are stacked against them. Along with being at a higher risk for heart disease, stroke and type 2 Diabetes, they are far more likely to suffer life-threatening respiratory compromise-particularly obstructed sleep apnea (OSA)-while receiving post-operative opioids.
Even more alarming:
- OSA occurs in 40% of obese female and 50% of obese males
- Incidences of OSA increase in proportion to patients’ levels of obesity
- The prevalence of OSA in patients deemed as extremely or morbidly obese is more than 77%
SEE ALSO: Treatment of Obesity
Obesity, opioids and OSA are a “deadly trio” that can alter the airway tone of obese patients; lead to chronic hypoventilation with mild hypercarbia when patients are resting before surgery; and increase the risk for aspiration and acute airway obstruction after extubation. In fact, airway obstruction and death have been reported in obese patients treated with only minimal doses of opioids.
Vigilance in All Phases of Treatment
- Although obese patients are most at risk for OSA after surgery, their pain management plans should incorporate all phases of their treatment. Keeping that perspective in mind, caregivers should:
- Identify an anesthesiologist with special interest in anesthetic care and pain management to serve as interdepartmental liaison
- Adopt “opioid sparing strategies” whenever possible
- Avoid opioids in combination with sedatives
- Continually monitor obese patients — no matter what dosage of opioids are used in their treatment
To help protect the safety of obese patients at every stage of treatment, we offer the following tips and recommendations.
PRE-OP RECOMMENDATIONS
- Conduct an anesthesiology consult at least one day prior to surgery
- Assess the patients for sleep apnea-polysomnography
- Instruct the patient to quit smoking at least six weeks before surgery
INTEROPERATIVE TIPS
- Use regional blocks as a sole anesthetic technique
- Use intraoperative capnography for monitoring of respiration
- Place patients in a non-supine posture during extubation and recovery
- Resume use of positive airway pressure device
POST-OPERATIVE/MONITORING RECOMMENDATIONS
- Use pulse oximetry for every patient with clinically significant obesity and/or if OSA was suspected during assessment
- Set alarms for less than 90% saturation for 10 seconds
- Treatment postop hypoxemia with early nasal intermittent positive pressure ventilation (NIPPV)
- Don’t rely entirely on intermittent “spot checks” of oxygenation (pulse oximetry) and ventilation (nursing assessment) to recognize indications of drug-induced respiratory depression in the postoperative period
- Continuously monitor oxygenation and ventilation of all obese patients receiving opioids postoperatively should be used
- Use capnography in patients requiring supplemental oxygen
Because they face an increased risk of suffering life-threatening OSA while receiving post-surgical opioids, obese patients should always be continuously monitored. Continuous electronic monitoring of obese patients is among the key ways that caregivers can protect obese patients from OSA-and steer clear of the potentially high costs of litigation and extended hospital stays that can result from OSA.
Maureen F. Cooney, DNP, FNP-BC, is a nurse practitioner in pain management at Westchester Medical Center, Valhalla, NY. Denise Sullivan, MSN, ANP-BC, is a nurse practitioner in pain management at Jacobi Medical Center, Bronx, NY.
Top 10 Opioid Safety Articles in 2014
Of the more than 125 articles we posted in 2014, below are 10 of the most read and most discussed articles on opioid safety (order is by publication date).
As you read through these articles, please ask yourself – has a new standard of care been established requiring continuous electronic monitoring by hospitals of all patients receiving opioids? Continue reading “Top 10 Opioid Safety Articles in 2014”
Lessons Learned from a Survey Assessing Nurses’ Awareness and Perceptions of Opioids and the Impact of Postsurgical Pain Management Medication Interventions
[Editor’s note: Amy Smalarz led the survey research. Lynn Razzano assisted with the article writing, but was not involved with the design, conduct, or analysis of the survey.]
By Amy Smalarz PhD, MHA (President and Co-Founder, Strategic Market Insight) and Lynn Razzano RN, MSN, ONCC (Clinical Nurse Consultant, Physician-Patient Alliance for Health & Safety)
Postsurgical pain management with opioids is tricky business. Not only do you have to think about which medication delivery interventions to use (PCA IV opioids, continuous wound infiltration, continuous epidural or femoral nerve block to name a few), but you must consider the type and amount of medication, then responsibly monitor the patient effectively. We know all too well about the dangers and challenges of ensuring the effectiveness of the medication as well as the safety of the patients; for example, The Joint Commission issued Sentinel Event Alert #49 and the Institute for Safe Medication Practices recently issued yet another Medication Safety Alert. Continue reading “Lessons Learned from a Survey Assessing Nurses’ Awareness and Perceptions of Opioids and the Impact of Postsurgical Pain Management Medication Interventions”
Physician-Patient Alliance Encouraged by First Meeting of National Coalition to Promote Continuous Monitoring of Patients on Opioids
The Physician-Patient Alliance for Health and Safety described the inaugural meeting of the National Coalition to Promote Continuous Monitoring of Patients on Opioids as a major step forward in the path to eliminate respiratory comprise, the second-most frequently occurring preventable patient safety issue in the United States.
Weekly Must Reads in Patient Safety (Nov 21, 2014)
After a brief pause to talk about the National Coalition to Promote Continuous Monitoring of Patients on Opioids, we are back to our weekly synopsis of patient safety articles and research. Continue reading “Weekly Must Reads in Patient Safety (Nov 21, 2014)”