Editor’s note: In this week’s must reads, we look at 3 new clinical guidelines and consider their impact on patient care.
Guideline for the Management of Patients With Atrial Fibrillation
The newly released “Guideline for the Management of Patients With Atrial Fibrillation” is a game changer for the use of anticoagulants. In a report by the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society, in Collaboration With the Society of Thoracic Surgeons, newer anticoagulants, known as non-vitamin K oral anticoagulants (NOACs), are recommended over the traditional warfarin to prevent stroke in people with atrial fibrillation (AFib).
This article was first published in Patient Safety Solutions on October 11, 2016. As part of our efforts to bring in expert viewpoints from across the #patientsafety community, we have reposted this with permission.
By Bradley T. Traux, MD
Our regular readers are well aware of the numerous controversies and limited evidence base regarding perioperative issues in patients with known obstructive sleep apnea (OSA) or those suspected as being at high risk for OSA (see the list of prior columns at the end of today’s column).
The Society of Anesthesia and Sleep Medicine has just published “Guidelines on Preoperative Screening and Assessment of Adult Patients with Obstructive Sleep Apnea”. This is a most thorough evaluation of the evidence base regarding multiple issues related to OSA in patients about to undergo surgery. One is struck by the lack of strong evidence for almost all the recommendations in the guideline, though we are not surprised since we’ve previously discussed most of the controversial issues. Yet this consensus guideline uses common sense and is very practical and appropriately balances concerns for patient safety with utilization of resources and concerns over timing of surgery.
Most importantly, Dr. Frederickson highlighted that the alerts provided by pulse oximetry can be a lagging indicator of patient ventilation, particularly when supplemental oxygen is administered. One solution to improving the care provided to patients is to understand that pulse oximetry is one part of a comprehensive monitoring strategy.Continue reading “3 Keys To Successfully Implementing Capnography”→
The Physician-Patient Alliance for Health & Safety (PPAHS) had the pleasure of interviewing Thomas W. Frederickson, MD, FACP, SFHM, MBA – lead author of the Society of Hospital Medicine RADEO guide (“Reducing Adverse Drug Events Related to Opioids”). The guide is a comprehensive clinician manual created with the aim to decrease opioid-related adverse events in an inpatient setting.
In a recent interview with a spotlight on the RADEO guide, Dr. Thomas Frederickson, MD, FACP, SFHM, MBA highlighted obstructive sleep apnea (OSA) as a key contributing condition to greater opioid use risk.
“Sleep apnea is the number one risk factor for respiratory depression associated with the use of opioids.
[…] Patients with obstructive sleep apnea are dependent upon their arousal mechanism in order to avoid respiratory depression and eventual respiratory failure.”
In addition to being the #1 contributing risk to opioid-induced respiratory depression, OSA is also common and often under diagnosed. Dr. Frederickson states that between 7% and 22% of the adult population has a degree of sleep apnea.