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Physician-Patient Alliance for Health & Safety: Addressing The Joint Commission Opioid Warnings Can Reduce Respiratory Depression and Improve Patient Safety in Hospitals

CHICAGO, Nov. 20, 2012 /PRNewswire/ -- The Physician-Patient Alliance for Health & Safety says recent research demonstrates how hospitals can address The Joint Commission Sentinel Event Alert, "Safe Use of Opioids in Hospitals."

Respiratory depression is an identified patient safety issue. As The Joint Commission recently stated:

"While opioid use is generally safe for most patients, opioid analgesics may be associated with adverse effects, the most serious effect being respiratory depression, which is generally preceded by sedation."

Respiratory depression has been associated with the use of opioid analgesics. However, a recent study by researchers at Wesley Medical Center in Wichita, Kan., suggests exhaled CO2 monitoring of patients using patient-controlled analgesia pumps could help reduce the occurrence of this adverse event. Specifically, Debra Fox, MBA, RRT-NPS, and Mark Wencel, MD, examined respiratory depression rates with the use of PCA pumps and intermittent IV opioids for pain management.

The Joint Commission, the American Society of Anesthesiologists and the Institute for Safe Medication Practices recommend the monitoring of exhaled CO2 to detect respiratory depression to increase patient safety with pain medication administration. Consequently, the Wesley Medical Center converted to a "smart" infusion pump system with integrated capnography. These smart pumps monitored levels of exhaled CO2, thereby detecting a potential adverse drug event and respiratory depression early on.

"Opioid analgesia may result in unrecognized or at least unattributed deaths. The risk of patient deaths from PCA prompted Wesley to invest in 'smart' pump technology with integrated capnography.  We are strong advocates for end tidal CO2 measurement with capnography over the sometimes suggested pulse oximetry," explained Ms. Fox.

In 2010 the Wesley Medical Center decided to develop a safe pain management program and formed a multidisciplinary team of providers to oversee its implementation, explains Dr. Wencel, who worked on the project. "We formed a multidisciplinary team made up professionals from respiratory care, pharmacy, anesthesia, and nursing. We included key physicians who collaborated on hospital-wide policies and procedures. Involving multiple stakeholders within the hospital meant that new processes received buy-in from key people," he says.

"Since implementing the smart infusion pump system with integrated capnography the incidence of severe ADRs has fallen to below 5 percent. Just three years ago the figure was three times that rate," says Ms. Fox.

Dr. Wencel adds, "The percentage of moderate and severe ADRs progressing to code blue fell from just under 13 percent to just over 4 percent. Through the first half of 2011, that progression rate sat at 0 percent."

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About PPAHS 

The Physician-Patient Alliance for Health & Safety (PPAHS) is an advocacy group devoted to improving patient health and safety. PPAHS supporters include physicians, patients, individuals, and organizations. PPAHS recently released a concise checklist that reminds caregivers of the essential steps needed to be taken to initiate Patient-Controlled Analgesia (PCA) with a patient and to continue to assess that patient's use of PCA. For more information and to download the PCA safety checklist, please visit

SOURCE Physician-Patient Alliance for Health & Safety
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