Abstract
Purpose: The aim of this quality improvement study was to promote nursing education regarding safe opioid administration and monitoring, along with identification of risk factors for Opioid Induced Respiratory Depression (OIRD) with subsequent application of continuous waveform capnography monitoring of at-risk post-surgical in-patients in an effort to help reduce Opioid Related Adverse Drug Events (ORADEs).|Background: Opioid analgesics rank among the drugs most frequently associated with life-threatening adverse drug events, the most serious being OIRD. Patients with specific health determinants have been identified as more at-risk for OIRD and subsequent ORADEs. End-tidal or waveform carbon dioxide monitoring (capnography) has been shown to consistently detect signs of OIRD earlier than other commonly used monitoring methods.|Sample/Setting: Patients admitted to the post-surgical unit of a 568-bed level two trauma center located in the mid-west between October 20th, 2019 through December 1st, 2019 were screened by virtual nurses for risk factors for OIRD.|Methods: Post-surgical in-patients found to have at least 4 risk factors for OIRD were identified, providers were called for a continuous capnography order, to be applied and monitored when the patient was under the influence of opioids (PO and IV). The implementation, documentation and potential for adverse events were monitored by bedside and virtual nurses during the timeframe.|Results: A total of two cases of OIRD and naloxone administration on the post-surgical unit were identified in the same timeframe in 2018. A total of 138 in-patients were screened by virtual nurses for risk-factors, 62 met criteria for continuous capnography monitoring, 40 patients had continuous capnography orders, 22 patients met criteria but did not have continuous capnography monitoring ordered, there were 2 STAT calls, both with naloxone administration during the study period.|Conclusion: There were 2 ORADE during the study time period. Thus, there was no reduction in the incidence of naloxone administration or ORADE during the comparable study timeframes. Only one of the two patients had an order for capnography, both patients received IV naloxone. In the patient whom did have a capnography order, it was noted that capnography values were only documented after naloxone was administered. Post intervention analysis confirmed the risk factors of age greater than 65 years, female sex and having known cardiovascular disease were present in almost all cases of ORADEs.