Hospital patients on opioids need more monitoring

Nearly 75 percent of hospitalized patients receiving opioids for pain management are not monitored according to hospital guidelines, report researchers.

The new study warns the vast majority of post-operative patients given opioid medications through intravenous infusions are not monitored often enough to detect respiratory depression, a potentially deadly result of overdose.

Post-operative patients are at highest risk for respiratory depression during the first 48 hours of recovery due to the combined effect of anesthesia and opioid medication, says Carla Jungquist, assistant professor in the School of Nursing at the University at Buffalo.

“No one should go into a hospital and leave dead because we were aggressive with their pain management yet didn’t provide safety measures.”

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For the study, published in the Journal of Nursing Administration, researchers analyzed more than 4,000 patient records at eight hospitals around the nation. The data uncovered whether nurses followed protocol to monitor blood oxygen saturation, respiratory rate, and level of sedation every two to four hours for the first 24 hours after surgery.

The findings show that just under 27 percent of patients received all three assessments every four hours. And only 8 percent of patients received the assessments every two hours.

Nurses measured sedation scores least often, with a third of patients receiving this assessment every four hours. The finding is concerning, since excessive sedation can precede respiratory depression. The poor compliance could be attributed to excessive workloads for nursing staff and to hospitals lacking policies that enforce guideline compliance.

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“When hospitals have a death, they quickly get on board and adopt policies that are more aggressive,” says Jungquist, who recommends that hospitals shorten four-hour intervals to every two hours. “Practice is starting to change, but it has taken way too many years and too many deaths.”

Although hospitals don’t track or report near misses—unplanned events that could have resulted in death or injury—the study found 55 instances where nursing staff used naloxone, an emergency treatment for opioid overdose. Those instances accounted for more than 1 percent of patients.

No patients who were assessed every two hours using all three measures received naloxone.

Researchers from the University of Pennsylvania, Vanderbilt University, Harvard University, the University of Connecticut, and the Anesthesia Patient Safety Foundation contributed to the work.

Source: University at Buffalo