title: Implementation of solutions to reduce opioid-induced oversedation and respiratory depression.
abstract: The implementation of interventions to mitigate the causes of opioid-induced oversedation and respiratory depression (OSRD) is reported.
  
  
  
  A single-site retrospective review of eligible rescue naloxone cases was conducted to identify the causes of opioid-induced OSRD in a hospital as well as to identify risk factors. A survey was used to assess potential opioid knowledge deficits among hospitalist prescribers. Based on the findings of the case reviews and results of the opioid knowledge assessments, a series of interventions to address noted deficiencies was implemented over the ensuing months, including enhanced monitoring for sedation, improved clinical decision support in the electronic medical record (EMR), and various adjustments to dosing for high-risk patients. The primary endpoint of our analysis was naloxone use for documented cases of opioid-induced OSRD to determine the effectiveness of the interventions. A mean of 16 OSRD events occurred per quarter before intervention implementation. An average of five risk factors (range, two to six) was found among OSRD cases, most commonly age of >60, obesity, and comorbidities of the kidneys and lungs. Deficiencies of clinical care were found in four inter-related domains: knowledge deficits, inadequate monitoring, failure to leverage the EMR, and cultural issues regarding pain assessments and sedation management.
  
  
  
  Implementation of solution bundles that utilized an EMR to create meaningful clinical decision support and cultural changes related to pain goals and communication about sedation level at an acute care hospital resulted in a fivefold reduction in OSRD events that has been sustained for two years.
authors.affiliation: Center for Health Care Improvement and Research Institute Outcomes Department, Anne Arundel Medical Center, Annapolis, MD.
authors.forename: Barry
authors.initials: B
authors.lastname: Meisenberg
authors.affiliation: Department of Pharmacy, Anne Arundel Medical Center, Annapolis, MD.
authors.forename: John
authors.initials: J
authors.lastname: Ness
authors.affiliation: Department of Pharmacy, Anne Arundel Medical Center, Annapolis, MD.
authors.forename: Sumati
authors.initials: S
authors.lastname: Rao
authors.affiliation: Reserach Institute Outcomes Department, Anne Arundel Medical Center, Annapolis, MD.
authors.forename: Jane
authors.initials: J
authors.lastname: Rhule
authors.affiliation: Department of Nursing Quality and Research, Anne Arundel Medical Center, Annapolis, MD.
authors.forename: Cathaleen
authors.initials: C
authors.lastname: Ley
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D020000:Decision Support Systems, Clinical; D004305:Dose-Response Relationship, Drug; D057286:Electronic Health Records; D007722:Health Knowledge, Attitudes, Practice; D020445:Hospitalists / Q000592:standards; D006801:Humans; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D010146:Pain / Q000188:drug therapy; D010147:Pain Measurement; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone
keywords: analgesics, opioid; narcosis; narcotics; patient safety