Alarm Fatigue, Opioid Safety, Patient Stories, Respiratory Compromise

PPAHS Joins Anesthesia Patient Safety Foundation in Call for a “Paradigm Shift” in Opioid Safety

by Sean Power
February 19, 2014

“It’s time for a change in how we monitor postoperative patients receiving opioids,” declares Dr. Robert Stoelting, president of the Anesthesia Patient Safety Foundation (APSF). “We need a complete paradigm shift in how we approach safer care for postoperative patients receiving opioids.” Read More

Opioid Safety, Patient Stories, Respiratory Compromise

Nursing Spot Checks for Patient Safety: A Nurse’s Perspective

(This article first published in Advance for Nurses, which covers the issues that matter most to nurses practicing in all areas of the profession. As that publication winds down, we have archived some articles here.)

By Malinda Loflin, RN, BSN. Malinda is a certified case manager at a hospital in Oklahoma City. During her 22 years as a registered nurse, her clinical experience has been in many specialty areas including the operating room, post-anesthesia care unit, and the emergency department. In 2006, her father tragically died of opioid-induced respiratory depression after a routine surgery. She shared her experience and the impact that it has had on her and her family at the 2011 Anesthesia Patient Safety Conference.

Nursing spot checks on postoperative patients receiving opioids are not enough to ensure the safety of patients. I say this as both a registered nurse who works at a large medical center and as a daughter who has had the misfortune of seeing her own father die between nurses’ spot checks. Read More

Opioid Safety, Patient Stories, Respiratory Compromise

Woman’s Death After Knee Surgery Calls Attention to Need for Better Monitoring

by Sean Power

The recent death of Helen Bousquet after what is being described by her son, Brian Evans, as “a basic routine procedure” at a hospital 40 minutes north of Boston highlights the need for better monitoring of patients after surgery. Mr. Evans is accusing the hospital of criminal negligence, according to an exclusive interview with Valley Patriot, as a result of how his mother’s visit to the hospital was handled by staff. Read More

Alarm Fatigue, Opioid Safety, Patient Stories, Respiratory Compromise

Adverse Drug Events Discussed at California Hospital Engagement Network

by Sean Power

The Physician-Patient Alliance for Health & Safety recently participated in a webinar hosted through the California Hospital Engagement Network, an organization that brings together hospitals to reduce patient harm by 40% and readmissions by 20% by the end of 2013.

The panel discussion looked at patient stories and best practices for preventing opioid related adverse events. The panelists included: Read More

Alarm Fatigue, Opioid Safety, Patient Stories, Respiratory Compromise

Recent Death of 17-Year Old From Unmonitored Tonsillectomy Should Never Have Happened

In Willow Grove, PA, 17-year old Mariah Edwards went into a surgical center to remove her tonsils and died.

ABC News recently reported that the outpatient tonsillectomy was a success. Following the procedure she was moved to a recovery room. In the lawsuit filed on behalf of the Edwards family, it provides that nurses administered a dose of the painkiller fentanyl, a potent, synthetic narcotic analgesic with a rapid onset and short duration of action. Read More

Opioid Safety, Respiratory Compromise

Update on CMS Proposed Quality Measure on PCA Patient Safety

We would like to thank all of those who submitted comments on the proposed quality measure being considered by CMS regarding the monitoring of patients using patient-controlled analgesia (PCA) pumps.

In the report submitted by the National Quality Forum to the United States Department of Health and Human Services, the measure was not endorsed and it was decided that the measure “requires modification or further development”. More particularly, the report provides: Read More

Opioid Safety, Respiratory Compromise

Monitoring Technology for PCA Pumps Can Prevent Adverse Events with Patient-Controlled Analgesia (PCA): So Why Are Hospitals Not Using It?

By Michael Wong

(This article has also been published in SurgiStrategies, which can be read here.)

According to its newly-updated, “How-to Guide: Prevent Harm from High-Alert Medication”, the Institute for Healthcare Improvement (IHI) looked at high-alert medications, which are “more likely than other medications to be associated with harm”.

One of the areas that the IHI singles out is narcotics. Read More

Opioid Safety, Respiratory Compromise

Post-Surgical Patients Require Better Monitoring

by Michael Wong

PPAHS encourages the adoption of the Anesthesia Patient Safety Foundation (APSF) recently released recommendations to improve the safety of patients by continuously monitoring patients following surgery. Read More