title: Instituting best practice for monitoring for opioid-induced advancing sedation in hospitalized patients.
abstract: BACKGROUND
  Adverse events related to opioid-induced unintended advancing sedation and respiratory depression in hospitalized patients are occurring with increased frequency, and these adverse events can have a negative impact on quality and cost outcomes.
  
  
  OBJECTIVE
  The goal of this paper is to inform nurses on best practices for preventing opioid-induced advancing sedation and respiratory depression, and to inform nurse leaders on implementation strategies to guide change in policies and practice.
  
  
  METHODS
  This paper presents an evidenced-based systematic approach for organizations to use in implementing strategies to reduce adverse events secondary to opioid-induced advancing sedation and respiratory depression in the hospitalized adult patient.
  
  
  RESULTS
  An action-oriented framework was developed based on the authors' experiences, strategies recommended by the Institute for Healthcare Improvement (IHI), the National Association of Healthcare Quality (NAHQ), and expert consensus-based best monitoring practices.
  
  
  CONCLUSIONS
  Nurse executives and nurse managers assume accountability for ensuring that patient care is aligned with the best evidence, practices, and regulatory mandates. The framework presented in this paper can help prevent opioid-induced advancing sedation and respiratory depression, and assist nurse leaders in implementation strategies to guide policies and practice.
authors.affiliation: Assistant Professor, University at Buffalo, the State University of New York, Buffalo, NY, USA.
authors.forename: Carla R
authors.initials: CR
authors.lastname: Jungquist
authors.forename: Chris
authors.initials: C
authors.lastname: Pasero
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Tripoli
authors.forename: Rachel
authors.initials: R
authors.lastname: Gorodetsky
authors.forename: Mark
authors.initials: M
authors.lastname: Metersky
authors.forename: Rosemary C
authors.initials: RC
authors.lastname: Polomano
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D054810:Deep Sedation / Q000592:standards*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000592:standards*; D010146:Pain / Q000188:drug therapy; D010348:Patient Care Team / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000451:nursing* / Q000517:prevention & control*
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives
keywords: monitoring; nursing practice; opioid; pain; postoperative; sleep disordered breathing