In all our columns on opioid-induced respiratory depression (OIRD) weve not come across an article more comprehensive and elegantly written than one in the May issue of the American Journal of Nursing (Jungquist 2017).
Jungquist and colleages put together a document focusing on risk assessment and tailoring monitoring to patient risk, type and route of opioid administration, previous history of opioid use, concomitant treatments, and the surgery or procedure performed. They provide an excellent table of risk factors for OIRD and emphasize the time frames in which OIRD events are most likely to occur.
They discuss the benefits, disadvantages, and barriers encountered in intermittent pulse oximetry, continuous pulse oximetry, capnography, or minute ventilation technology. Most of all, they stress the importance of monitoring a patients sedation level, using tools such as the POSS (Pasero Opioid-Induced Sedation Scale) or RASS (Richmond Agitation-Sedation Scale), to help determine when a patient might be prone to OIRD. Also stressed is the importance of assessing level of sedation and response to pain at a time the peak effect of the opioid is expected. And they note that the frequency of monitoring must be tailored to multiple factors rather than being strictly standardized. Importantly, they note the importance of letting the patient and family know the patient will likely be wakened at night for assessment and that this is a critical patient safety need. And they stress the importance of recognizing trends rather than relying solely on single threshold levels.
They stress another point we have often made: there must be guidelines and policies for nurses to prepare and administer naloxone in appropriate circumstances. They describe how naloxone should be administered and what to watch for. (The only thing we did not find in the article was a discussion of the phenomenon of renarcotization.)
Jungquist and colleagues are to be commended for this outstanding article.
Our other Patient Safety Tips of the Week pertaining to opioid-induced respiratory depression and PCA safety:
Jungquist CR, Smith K, Nicely KLW, Polomano RC. Monitoring hospitalized adult patients for opioid-induced sedation and respiratory depression Am J Nurs 2017; 117(3 Supp): S27-S35