American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression.
ABSTRACT As the complexity of analgesic therapies increases, priorities of care must be established to balance aggressive pain management with measures to prevent or minimize adverse events and to ensure high quality and safe care. Opioid analgesia remains the primary pharmacologic intervention for managing pain in hospitalized patients. Unintended advancing sedation and respiratory depression are two of the most serious opioid-related adverse events. Multiple factors, including opioid dosage, route of administration, duration of therapy, patient-specific factors, and desired goals of therapy, can influence the occurrence of these adverse events. Furthermore, there is an urgent need to educate all members of the health care team about the dangers and potential attributes of administration of sedating medications concomitant with opioid analgesia and the importance of initiating rational multimodal analgesic plans to help avoid adverse events. Nurses play an important role in: 1) identifying patients at risk for unintended advancing sedation and respiratory depression from opioid therapy; 2) implementing plans of care to assess and monitor patients; and 3) intervening to prevent the worsening of adverse events. Despite the frequency of opioid-induced sedation, there are no universally accepted guidelines to direct effective and safe assessment and monitoring practices for patients receiving opioid analgesia. Moreover, there is a paucity of information and no consensus about the benefits of technology-supported monitoring, such as pulse oximetry (measuring oxygen saturation) and capnography (measuring end-tidal carbon dioxide), in hospitalized patients receiving opioids for pain therapy. To date, there have not been any randomized clinical trials to establish the value of technologic monitoring in preventing adverse respiratory events. Additionally, the use of technology-supported monitoring is costly, with far-reaching implications for hospital and nursing practices. As a result, there are considerable variations in screening for risk and monitoring practices. All of these factors prompted the American Society for Pain Management Nursing to approve the formation of an expert consensus panel to examine the scientific basis and state of practice for assessment and monitoring practices for adult hospitalized patients receiving opioid analgesics for pain control and to propose recommendations for patient care, education, and systems-level changes that promote quality care and patient safety.
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ABSTRACT: This paper provides those who care for orthopaedic patients with evidence-supported international perspectives about acute nursing care of the older adult with fragility hip fracture. Developed by an international group of nurse experts and guided by a range of information from research and clinical practice, it focuses on nurse sensitive quality indicators during the acute hospitalisation for fragility hip fracture. Optimal care for the patient who has experienced such a fracture is the focus here. This includes in this part: PainDelirium and in the second, subsequent, part Pressure UlcersFluid Balance/NutritionConstipation/Catheter Associated Urinary Tract Infection Vigilant nursing assessment and prompt intervention may prevent the development of the complications we discuss. If they do occur and are identified early on, they may resolve with appropriate and timely nursing management. This “tool kit” has been developed under the auspices of the International Collaboration of Orthopaedic Nursing (ICON) a coalition of national associations of orthopaedic nursing (www.orthopaedicnursing.org).
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ABSTRACT: Opioid analgesia is the primary pharmacologic intervention for managing pain. However, opioids can cause various adverse effects including pruritus, nausea, constipation, and sedation. Respiratory depression is the most fatal side effect. Therefore, cautious monitoring of respiratory status must be done after opioid administration. Here, we report a patient who suffered from respiratory depression with deep sedation and aspiration pneumonitis after intrathecal morphine administration.The Korean journal of pain 04/2012; 25(2):126-9.
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ABSTRACT: The American Society for Pain Management Nursing convened a task-force to develop guidelines on monitoring for opioid-induced seda-tion and respiratory depression. Part of the guideline development was the determination of nursing practice patterns related to moni-toring and preventing respiratory depression during the administra-tion of analgesics for pain. One hundred and forty-seven responses were received from 90 unique institutions across the United States. Monitoring adults with intermittent pulse oximetry while using intravenous patient-controlled analgesia (IV PCA) was 58%. Adults were monitored with continuous pulse oximetry by 25% of respon-dents. When using continuous epidural analgesia, 56% of patients were monitored intermittently, and 40% were monitored continu-ously. The use of end tidal CO2 (ETCO2) monitoring was much less, with 2.2% patients on epidural therapy, and 1.5% of institutions were using ETCO2 with IV PCA. The survey also included the location of the alarm, respiratory parameters for alarms, changes in procedures reported by institutions, and definitions of high-risk patients. Ó 2013 by the American Society for Pain Management Nursing It has been a long-standing practice for professional societies to conduct membership surveys to inform the work of the organization. Most professional organizations conduct a practice analysis for the purposes of: (1) defining the state of the practice or specialization, (2) establishing a body of knowledge about specific practices, (3) generating the frequency and importance of practices/activities as the foundations for core curricula and certification exam-inations, and (4) promoting professional development for the delivery of care (Baghi, Panniers, & Smolenski, 2007; Matarese et al., 2012; Muckle, Apatov, & Plaus, 2009). Other professional societies have used practice analysis surveys to assess the state of practice (ACCF/AHATaskforce on practice guidelines, 2010; Gorman et al., 2010; Matarese et al., 2012).