Opioid Safety, Respiratory Compromise

Dentistry and Death: More Laws or More Education?

By Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety)

Editor’s Note: Last week, we asked whether the use of birth control is a patient safety risk because of possible development of blood clots. In this post, the question is – do we need more laws or more education to help prevent anesthesia-related deaths in dental procedures and oral surgery.

Most people would not associate dentistry with death – discomfort perhaps – but not death.

However, the death of Caleb Sears forces us to consider the possibility of death in dentistry – or, more accurately, oral surgery:

Caleb Sears was a healthy six-year-old living in the Bay Area. He was in his first year of elementary school and just starting to read and write. He loved playing with his little sister, climbing trees, singing Les Miserables, and making up funny stories about llamas and time machines. Read More

Must Reads, Opioid Safety, Respiratory Compromise

2 Lessons from the Death of 9-Year Old Solomon Womack from Tonsillectomy

MSN reports in a recent article, “Boy, 9, Dies After Undergoing Routine Tonsil Removal” that “Solomon Womack of Milwaukee was pronounced dead Friday, according to the Milwaukee County Medical Examiner’s Office. Days earlier, he’d reportedly undergone a tonsillectomy.”

As CBS Milwaukee reported, the 9-year old “was given a dose of Oxycodone, then sent home. Later that evening, Solomon’s parents gave him another prescription dose of Oxycodone and noticed about an hour later that he was having trouble breathing. The parents called 911, and the boy was brought to Children’s Hospital. He was pronounced brain dead days later.” Read More

Opioid Safety, Respiratory Compromise

Two Practices to Adopt After Pediatric Opioid Trial Halted

By Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety)

With more than 500,000 pediatric tonsillectomies performed each year in the United States, removal of tonsils is one of the most common surgeries performed on children. According to the American Academy of Otolaryngology Head and Neck Surgery, tonsillectomy is performed 20 percent for infection and 80 percent for obstructive sleep apnea. Read More

Respiratory Compromise

Procedural Sedation guidelines for Tonsillectomy and Adenoidectomy: The Basics

By Lynn Razzano, RN, MSN, ONCC (Clinical Nurse Consultant, Physician-Patient Alliance for Health & Safety)

The American College of Emergency Physicians (ACEP) defines procedural sedation as:

“a technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function. Procedural sedation and analgesia (PSA) is intended to result in a depressed level of consciousness that allows the patient to maintain oxygenation and airway control independently.”

Read More

Alarm Fatigue, Patient Stories, Respiratory Compromise

Making the Case for Maximum Alarm Management and Prevention of Alarm Fatigue

By Lynn Razzano, RN, MSN, ONCC (Clinical Nurse Consultant)

17-year old Mariah Edwards went in for a procedure that is performed countless times each year – a tonsillectomy. Recovering after the successful and very routine procedure, she was administered a dose of fentanyl to manage her pain. Although she was monitored continuously electronically, one of the attending nurses admitted on discovery that the monitor was muted for sound.

The settlement: $6 million. But, what really is $6 million to the parents of Mariah Edwards who have lost a child? What is the emotional toll to her nurses and other caregivers? Read More