Navigation Links
Physician-Patient Alliance for Health & Safety: Monitoring the High-Acuity Patient: Does Risk Stratification Increase or Decrease Patient Safety?
Date:7/12/2012

CHICAGO, July 12, 2012 /PRNewswire/ -- According to Michael Wong of the Physician-Patient Alliance for Health & Safety, the topic of who is a suitable candidate for outpatient surgery is front and center with productivity pressures being intense at ambulatory surgery centers. However, with surgery often comes the necessity of the use of opioids for pain control.

As Mr. Wong explains, "Studies have shown that any patient receiving opioids may be at risk of postoperative respiratory depression and if undetected, respiratory arrest  (also known as "Code Blue"). The most common antecedents to cardiopulmonary arrest are of respiratory origin. Respiratory decompensation—as evidenced by tachypnea, bradypnea, hypoxia, hypercarbia or changes in mental status—are often the earliest warning signs of physiologic instability. Monitoring respiratory function and level of consciousness are especially important in detecting and preventing adverse events for patients receiving opioids and sedatives."

According to the report Ambulatory Surgery in the United States, 2006, the number of outpatient surgeries in the United States increased from 20.8 million in 1996 to 34.7 million in 2006. While outpatient surgeries only accounted for about half of all surgeries in 1996, by 2006 they made up nearly two-thirds of all surgeries in 2006.

As Frank Overdyk, MD (Professor of Anesthesiology, Medical University of South Carolina) says, "There is often a sentiment that "it's only minor surgery". While a surgery may indeed be "minor" or less intensive and complicated, and non opioid analgesics are preferred in these cases, opioids are still frequently required for adequate postoperative pain control."

The Anesthesia Patient Safety Foundation convened a symposium in 2006 on the dangers of postoperative opioids, and the consensus opinion was that opioid-induced respiratory depression (OIRD) remains a significant and preventable threat to patient safety for which institutions must have zero tolerance. Moreover, in 2011, APSF reiterated that clinically significant drug-induced respiratory depression (oxygenation and/or ventilation) in the postoperative period remains a serious patient safety risk that continues to be associated with significant morbidity and mortality.

Unrecognized postoperative respiratory failure that results in cardiopulmonary arrest (CPA) is a daily occurrence at healthcare facilities across the United States. Since CPA results in death or anoxic brain injury in the majority of cases, these events have been termed "Failure to Rescue (FTR)". FTR is the first and third most common patient safety-related adverse events affecting the Medicare population in U.S. hospitals, accounting for 113 events per 1,000 at-risk patient admissions. Moreover, fifty percent of Code Blue events involve patients receiving opioid analgesia.[1]

Postoperative patients usually receive opioid analgesia by patient-controlled analgesia (PCA). PCA has become part of accepted medical practice and is generally considered more effective and safer than conventional IM (Intramuscular) injection of opioids.

However, as Dr. Overdyk explains, "conventional PCA monitoring by nurses at the bedside fail to detect frequent episodes of slow breathing (bradypnea) and desaturation that continuous electronic monitoring have revealed."[2] 

The current standard of care for postoperative monitoring typically require vital signs and less commonly a SpO2 value, initially at 30-min intervals, but thereafter at intervals as far as 2–4 h apart. As recent APSF recommendations and conclusions state:

Intermittent 'spot checks' of oxygenation (pulse oximetry) and ventilation (nursing assessment) are not adequate for reliably recognizing clinically significant evolving drug-induced respiratory depression in the postoperative period.

As Dr. Overdyk concludes, "Patient surveillance systems that use continuous monitoring with oximetry and capnography would facilitate early recognition of patient deterioration."

[1] Fecho K, Jackson F, Smith F, Overdyk F: In-hospital resuscitation: Opioids and other factors influencing survival. Ther Clin Risk Manag 2009; 5:961–8

[2] Overdyk FJ, et. al., "Continuous Oximetry/Capnometry Monitoring Reveals Frequent Desaturation and Bradypnea During" Patient-Controlled AnalgesiaAnesth Analg 2007;105:412–8


'/>"/>
SOURCE Physician-Patient Alliance for Health & Safety
Copyright©2012 PR Newswire.
All rights reserved

Related medicine technology :

1. Physician-Patient Alliance for Health & Safety: Monitoring Technology for PCA Pumps Can Prevent Adverse Events: So Why Are Hospitals Not Using It?
2. Cleveland Clinic Lou Ruvo Center for Brain Health and MedAvante Announce Alliance
3. Bacterin International Signs Its Fourth National GPO Contract with the Premier healthcare alliance
4. The UCB-Harvard Research Alliance Expands and Moves Forward
5. Nonin Medicals Tissue Oximetry System Recognized at Premier Healthcare Alliance Innovation Celebration
6. Premier healthcare alliance honors Atrium Medical Corporation for operational excellence
7. Elekta and The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital Sign Strategic Alliance to Further Cancer Research
8. Rittal Corp. Joins the HP ProActive Insight Architecture Alliance
9. UBM Canon, the Global MedTech Authority, Announces Strategic Alliance with ITG Market Research, a Preeminent Industry Research Organization
10. Amendia, Inc. and Medline Industries, Inc. Announce Investment and Strategic Business Alliance
11. PDR and the iHealth Alliance Announce New Drug Safety Certification for EHRs
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:8/15/2017)... AccuGenomics, Inc., a diagnostic company based in ... the company has provided an AccuKit to the HIV ... Chapel Hill and to Qura Therapeutics for evaluation in ... HIV reservoir and viral expression in human CD4+ T ... Center is a joint initiative between the University of ...
(Date:8/8/2017)... Aug. 8, 2017  BioLineRx Ltd. (NASDAQ/TASE: BLRX), a ... reports its financial results for the second quarter ended ... the second quarter 2017 and to date: ... development programs for the Company,s lead project, BL-8040: ... study with BL-8040 as novel stem cell mobilization treatment ...
(Date:8/7/2017)... 2017  Diplomat Pharmacy, Inc. (NYSE: DPLO), the nation,s largest ... June 30, 2017.  All comparisons, unless otherwise noted, are to ... Second Quarter 2017 Highlights include: ... an increase of 3.5% Total prescriptions dispensed ... of 7.5% versus 7.6% Gross profit ...
Breaking Medicine Technology:
(Date:8/18/2017)... ... August 18, 2017 , ... More than 20,000 pairs of ... Congo (DRC) thanks to an ambitious venture that conjoined the passions of an NBA ... support of the Liberty community. These shoes will save lives from the rampant infections ...
(Date:8/18/2017)... ... August 18, 2017 , ... Mediaplanet today announces the launch ... lifestyles and highlighting the importance of proactive eye and ear health. The campaign ... latest innovations in hearing aid technology. , In this issue, the National ...
(Date:8/18/2017)... , ... August 18, 2017 , ... ... handling handheld devices. Through an educational webinar, they will present the line of ... chance to learn how easy you can automate everyday pipetting tasks. , Ideal ...
(Date:8/18/2017)... ... 2017 , ... Radabaugh & Associates, a family managed agency ... West Virginia, is embarking on a cooperative charity effort with the Chestnut Mountain ... Chestnut Mountain Ranch (CMR) is a Christ-centered boarding school for young men offering ...
(Date:8/18/2017)... ... August 18, 2017 , ... The Brian Gifford Agency, an ... is campaigning in support of Campagna Academy in a charity drive to provide for ... Boys’ Town of Indiana,” Campagna Academy is a nonprofit organization that has offered critical ...
Breaking Medicine News(10 mins):