Opioid Safety: Is Your Patient at Risk for Respiratory Depression?

Smith, Lisa Hartkopf

doi:10.1188/07.cjon.293-296

Cited by 22 publications

(14 citation statements)

References 23 publications

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“…8 The most common of these ORADEs include gastrointestinal (GI) effects such as constipation, ileus, nausea, and vomiting; central nervous system effects including sedation, euphoria, and delirium; pruritus; urinary retention; and more serious adverse effects such as respiratory depression. [8][9][10] Several patient clinical and demographic characteristics have been demonstrated to play a role in increased ORADE risk. Perioperative and intraoperative treatment factors associated with ADE incidence include specific procedure type, longer duration of surgery, use of volatile intraoperative anesthetics, general versus regional anesthesia, and postoperative opioid dose and route of administration.…”

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confidence: 99%

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Minkowitz¹,

Scranton

Gruschkus

et al. 2014

JMCP

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BACKGROUND: Opioid-related adverse drug events (ORADEs) are common causes of hospitalization and increased health care costs. OBJECTIVES: To (a) estimate rates of specific adverse drug events (ADEs) among gastrointestinal (GI) surgery patients receiving postoperative opioids; (b) examine the utility of a risk-scoring model in categorizing patients at high risk of experiencing ORADEs; and (c) quantify potential clinical/economic benefits of targeting high-risk GI surgical patients for opioid-sparing regimens in terms of hospitalization cost, length of stay (LOS), and 30-day readmission rates. METHODS: Using a retrospective design based on an administrative database, patients with an inpatient surgical procedure between January 1, 2010, and December 31, 2010, were included. GI surgical patients aged > 18 years followed from admission through 30 days postdischarge were characterized as high or low risk using clinical/demographic characteristics and were evaluated for several outcomes. Using multivariate logistic regression, the ORADE incidence, total hospitalization cost, LOS, and 30-day readmissions were compared for high-risk and low-risk patients. RESULTS: In 87.8% (n = 3,235) of the surgical population, there was a strong concordance between risk assignment and ORADE incidence. Among the remaining 12.2% (n = 449) of patients, 5.5% (n = 202) were low risk with an ORADE, and 6.7% (n = 247) were high risk without an ORADE. Overall, 20.6% (n = 344) of high-risk patients experienced ≥ 1 ORADE (mean cost: $31,988; LOS: 12.1 days) compared with only 5.3% (n = 107) of lowrisk patients (mean cost: $25,216; LOS: 8.0 days). High-risk patients had higher hospitalization costs and longer LOS than low-risk patients, respectively (mean cost: $19,234 vs. $13,036; mean LOS: 6.8 days vs. 3.3 days). These differences correspond to 47.0% higher costs for high-risk patients and an LOS approximately twice as long compared with low-risk patients. CONCLUSIONS: Patient clinical/demographic characteristics influence the risk of developing ORADEs. Risk assessment tools can effectively identify high-risk patients, thereby enabling interventions that can reduce ORADEs, decrease hospital costs, and improve postsurgical experiences for patients.

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confidence: 99%

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Minkowitz¹,

Scranton

Gruschkus

et al. 2014

JMCP

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“…Another important barrier to adequate pain management is the exaggeration of certain opioid side effects [55]. One of these side effects is respiratory depression, which is infrequent amongst patients taking opioids regularly and over a long period [56]. Despite this, only 16% of the RNs on the intervention ward stated the correct incidence rate (Item 26, Table 4) and the remainder overstated the incidence rate of respiratory depression.…”

Section: Discussionmentioning

confidence: 99%

Can a theory-based educational intervention change nurses’ knowledge and attitudes concerning cancer pain management? A quasi-experimental design

Gustafsson

Borglin

2013

BMC Health Serv Res

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BackgroundRegistered Nurses (RNs) play an important role in caring for patients suffering from cancer pain. A lack of knowledge regarding pain management and the RNs’ own perception of cancer pain could act as barriers to effective pain management. Educational interventions that target RNs’ knowledge and attitudes have proved promising. However, an intervention consisting of evidence-based practice is a multifaceted process and demands behavioural and cognitive changes to sustain the effects of the intervention. Therefore, our study aimed to investigate if a theory-based educational intervention could change RNs’ knowledge and attitudes to cancer pain and pain management, both four and 12 weeks after the start of the intervention.MethodsA quasi-experimental design with non-equivalent control groups was used. The primary outcome was measured using a modified version of the instrument Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKAS) at baseline, four weeks and 12 weeks after the start of the intervention to evaluate its persistence. The intervention’s educational curriculum was based on the principles of Ajzen’s Theory of Planned Behaviour and consisted of interactive learning activities conducted in workshops founded on evidence-based knowledge. The RN’s own experiences from cancer pain management were used in the learning process.ResultsThe theory-based educational intervention aimed at changing RNs knowledge and attitudes regarding cancer pain management measured by primary outcome NKAS resulted in a statistical significant (p<0.05) improvement of total mean score from baseline to four weeks at the intervention ward.ConclusionsThe findings of this study, suggest that a theory-based educational intervention focused at RNs can be effective in changing RN’s knowledge and attitudes regarding cancer pain management. However, the high number of dropouts between baseline and four weeks needs to be taken into account when evaluating our findings. Finally, this kind of theory-based educational intervention with interactive learning activities has been sparsely researched and needs to be evaluated further in larger projects.Trial registrationClinical Trials. Gov: NCT01313234

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“…Equianalgesic doses of opioids result in comparable degrees of respiratory depression (Schug et al, 1992). Human patients at increased risk for opioid-related respiratory depression may be those with advanced age, obesity, a history of sleep apnea, concurrent sedation, and renal or hepatic disease that might affect drug metabolism and clearance (Smith, 2007). Presumably, some of these same factors would apply to canine patients receiving perioperative opioids.…”

Section: Discussionmentioning

confidence: 99%

A comparison of the effects of hydromorphone HCl and a novel extended release hydromorphone on arterial blood gas values in conscious healthy dogs

Wunsch¹,

Schmidt²,

Krugner‐Higby³

et al. 2010

Research in Veterinary Science

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The purpose of this study was to evaluate arterial blood gases in dogs that were given hydromorphone or extended release liposome-encapsulated hydromorphone (LEH). Dogs were randomly administered LEH, n = 6, (2.0 mg kg−1), hydromorphone, n = 6, (0.2 mg kg−1) or a placebo of blank liposomes, n = 3, subcutaneously on separate occasions. Arterial blood samples were drawn at serial time points over a 6-h time period for blood gas analysis. There was no change from baseline values in PaCO2, PaO2, (HCO3−), pH, and SBEc in the dogs that received the placebo. Administration of hydromorphone resulted in significant increases in PaCO2 (maximum (mean + SD] 44.4 + 1.1 mm of Hg) and significant decreases in PaCO2 (minimum (mean + SD) 82.4 + 4.7 mm of Hg) and pH (minimum (mean + SD) 7.31 + 0.01) compared with baseline. Administration of LEH resulted in significant increases in PaCO2 (maximum (mean + SD) 44.6 + 0.9 mm of Hg) and significant decreases in PaO2 (minimum (mean + SD) 84.8 + 2.6 mm of Hg) and pH (minimum (mean + SD) 7.34 + 0.02) compared with baseline. There was no significant difference between these two groups at any time point. The changes observed in PaCO2, PaO2, and pH, however, were within clinically acceptable limits for healthy dogs. LEH was determined to cause moderate changes in arterial blood gas values similar to those caused by hydromorphone.

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Opioid Safety: Is Your Patient at Risk for Respiratory Depression?

Cited by 22 publications

References 23 publications

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Can a theory-based educational intervention change nurses’ knowledge and attitudes concerning cancer pain management? A quasi-experimental design

A comparison of the effects of hydromorphone HCl and a novel extended release hydromorphone on arterial blood gas values in conscious healthy dogs

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