title: Avoiding Adverse Events Secondary to Opioid-Induced Respiratory Depression: Implications for Nurse Executives and Patient Safety.
abstract: BACKGROUND
  Guidelines with recommendations for monitoring type and timing of hospitalized patients for opioid-induced respiratory depression have been published, yet adverse events continue to occur.
  
  
  OBJECTIVE
  This study reports on the monitoring practices of 8 hospitals that volunteered to pilot test a Centers for Medicare & Medicaid Services e-quality measure that was under development. Recommendations for nurse executives are provided to support patient safety.
  
  
  METHODS
  Data on monitoring practices were collected retrospectively from the electronic medical records at 8 hospitals on all patients receiving intravenous (IV) opioids for more than 2.5 continuous hours via patient-controlled analgesia (PCA). Analysis included the percentage of patients who were monitored according to specific standards developed by a panel of technical experts with comparisons of naloxone use to monitoring practices.
  
  
  RESULTS
  Recommended patient assessments occurred in only 8.3% of the patients. No patients who were assessed at least every 2.5 hours received naloxone.
  
  
  CONCLUSIONS
  Care for patients receiving IV PCA is lacking in adherence to latest safety standards. Nurse executives must implement structures and processes to promote vigilance with evidence-based monitoring practices.
authors.affiliation: Author Affiliations: Assistant Professor (Dr Jungquist), School of Nursing, University at Buffalo, New York; Assistant Professor of Anaesthesia (Dr Correll), Harvard Medical School, Boston, Massachusetts; Professor and Chair (Dr Fleisher), Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia; Professor and Chairman (Dr Gross), Department of Anesthesiology, University of Connecticut School of Medicine, Farmington; Assistant Professor (Dr Gupta), Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee; Pain Management Clinical Consultant (Ms Pasero), El Dorado Hills, California; President (Dr Stoelting), Anesthesia Patient Safety Foundation, Indianapolis, Indiana; Professor of Pain Practice (Dr Polomano), University of Pennsylvania School of Nursing, Philadelphia.
authors.forename: Carla R
authors.initials: CR
authors.lastname: Jungquist
authors.forename: Darin J
authors.initials: DJ
authors.lastname: Correll
authors.forename: Lee A
authors.initials: LA
authors.lastname: Fleisher
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gross
authors.forename: Rajnish
authors.initials: R
authors.lastname: Gupta
authors.forename: Chris
authors.initials: C
authors.lastname: Pasero
authors.forename: Robert
authors.initials: R
authors.lastname: Stoelting
authors.forename: Rosemary
authors.initials: R
authors.lastname: Polomano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000453:epidemiology* / Q000451:nursing / Q000517:prevention & control; D012189:Retrospective Studies; D019035:Rural Health Services; D017751:Safety Management; D014481:United States / Q000453:epidemiology; D019037:Urban Health Services; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid