Continuous Monitoring Of Patients On Opioids

The Problem

All hospital patients are susceptible to Opioid-Induced Ventilatory Impairment—whether opioid-naïve or tolerant; whether the regimen is oral or via or an I.V.

Current monitoring protocols at most hospitals call for “spot checks” of patients receiving post-surgery opioids for pain management on general care floors. Spot checks are intermittent electronic monitoring of a patient’s breathing rate typically performed every 2-4 hours if the patient has no risk factors.

Every year, many patients suffer permanent harm or die in hospitals after having had successful surgery. No longer under the around-the-clock care of ICU staff, inpatients who are receiving opiate-based pain medication can experience breathing difficulties that may result in brain damage or death.  Although underlying factors such as obesity and sleep disorders can increase the risk, no one is immune to this risk – a risk that can be all but eliminated with continuous electronic monitoring.

Continuous electronic monitoring of patients is not a standard of care.

The AAMI Foundation believes the evidence exists to demonstrate that continuous electronic monitoring results in a significant reduction of adverse events.  Until this becomes standard practice, we urge all individuals to become informed, to manage their safety proactively, and to prepare for the possibility that they, or a loved one, are admitted to a hospital for surgery.

The Vision

We recommend improving the safety for non-DNR*, patients receiving parenteral opioids by supplementing ongoing assessments of sedation level and respiratory status with continuous electronic monitoring and opioid sparing strategies (i.e. multimodal analgesia) for timely detection of respiratory decompensation. Experience from early adopters demonstrates that continuous respiratory monitoring combined with education, culture change, and process improvements—including effective management of clinical alarms—increases the quality of patient care in a financially sustainable manner.

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