Incidence and characteristics of naloxone use in postoperative pain management: a critical examination of naloxone use as a potential quality measure.
The administration of naloxone may be an important monitor of the quality and safety of postoperative pain management. However, studies that support the use of naloxone as a quality measure are absent. The purposes of this study are to determine the incidence and factors associated with naloxone administration in the postoperative setting and to critically examine naloxone as a potential quality measure. Participants included all postoperative adult inpatients at an academic hospital who received naloxone and an equal number of matched control patients who did not receive naloxone during the calendar year 2003. Medical record audits were performed to examine patient demographics, relevant medical history, postoperatively administered analgesics and central nervous system depressants, documented sedation and respiratory assessments, reason provided for naloxone administration, and patient outcome. Naloxone was administered to .53% (56/10,511) of all adult inpatient postoperative patients. Patients who received naloxone were significantly older and received more central nervous system depressants than cohorts. No significant differences were found in comorbidities, route of opioid administration, or amount of opioids taken by the two groups. Reversal of excessive opioid-induced sedation was the primary reason provided for naloxone administration. However, 25% of the patients were later determined to have a new diagnosis that contributed to sedation. Examination of naloxone administration proved useful in uncovering deficits in structures and processes of care. However, caution is warranted when using naloxone as a quality measure to avoid the implication that higher use indicates opioid analgesic over-treatment or error.
Gordon
Debra B
DB
University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA. db.gordon@hosp.wisc.edu
Pellino
Teresa A
TA
D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning; D016022:Case-Control Studies; D002492:Central Nervous System Depressants / Q000506:poisoning; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D024802:Nurse's Role; D009730:Nursing Assessment; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D010043:Outcome and Process Assessment, Health Care; D010149:Postoperative Pain / Q000188:drug therapy* / Q000451:nursing; D018579:Patient Selection; D011182:Postoperative Care / Q000379:methods / Q000451:nursing / Q000592:standards; D019984:Quality Indicators, Health Care; D013997:Time Factors; D014193:Trauma Centers
D000701:Analgesics, Opioid; D002492:Central Nervous System Depressants; D009292:Narcotic Antagonists; D009270:Naloxone