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

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

SOURCE Physician-Patient Alliance for Health & Safety
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