5 Strategies to Keep Patients Safe When Receiving Opioids

In the first of this two-part interview, Dr. Frederickson discusses five key steps to identify and address patient conditions that pose a greater risk of respiratory depression.  For readers that have yet to listen to the podcast, please click here; it's an insightful interview relevant for any clinician working in quality improvement or directly with patients prescribed opioids.

In part two of his interview, Dr. Frederickson discusses five key strategies to improve the monitoring of patients receiving opioids:

#1. Account for supplemental oxygen when monitoring

Administering supplemental oxygen adds an additional complication to monitoring that must be addressed, says Dr. Frederickson:

"[I]n opioid-induced respiratory or opioid induced respiratory failure, decrease in the oxygen saturation is a late marker rather than early warning sign. So, if you're monitoring oxygen saturation as a strategy to detect respiratory failure early, you have to understand that it's not an early warning sign - in fact is a late sign.  So, if you add oxygen supplemental oxygen it delays that effect even further."

#2. Develop a comprehensive monitoring strategy

According to Dr. Frederickson, a key to accounting for such lagging indicators of respiratory depression is the development of a comprehensive monitoring strategy, including pulse oximetry and capnography.  During the interview, he highlights the unique advantages and limitations of these monitoring technologies.

#3. Recognize that pulse oximeters are a late marker of respiratory failure

Particularly with the case of supplemental oxygen administration, emphasized Dr. Frederickson, the signs of respiratory depression can only be recognized in its later stages:

"Certainly, the limitation that we just talked about - decreased oxygen saturation tends to be a late marker of respiratory failure, not an early marker."

#4. Monitoring with capnography provides an earlier warning of respiratory distress

Capnography can provide an earlier warning of respiratory distress, most notably for patients with the highest risk profiles, such as those with obstructive sleep apnea:

"[I]t gets at more of the early warning signs of respiratory depression and respiratory failure.  It approximates that minute ventilation that we talked about, by looking at the approximation of end tidal CO2 and kind of continuously monitoring the respiratory rate. So, it does give you a little bit of an insight - more of an insight than pulse oximetry would to what's happening in terms of early warning for impending respiratory failure."

#5. Understand the 3 critical patterns of unexpected hospital deaths and how to intervene

Dr. Frederickson ends the interview by talking about what studies have revealed about three clinical patterns of unexpected hospital deaths.  Most importantly, he emphasizes that opioids can play a part in all three patterns, with overlapping mechanisms of action.

For more on these five strategies for keeping patients safe when receiving opioids, please visit the PPAHS blog at http://www.ppahs.org/blog/

To listen to the second part of the interview on YouTube, please click here.

About Physician-Patient Alliance for Health & Safety

Physician-Patient Alliance for Health & Safety is a non-profit 501(c)(3) whose mission is to promote safer clinical practices and standards for patients through collaboration among healthcare experts, professionals, scientific researchers, and others, in order to improve healthcare delivery. For more information, please go to www.ppahs.org.

Video - http://origin-qps.onstreammedia.com/origin/multivu_archive/PRNA/ENR/PPAHS_Dr_Thomas_Frederickson.mp4

Logo - http://photos.prnewswire.com/prnh/20131024/CG03341LOGO

SOURCE Physician-Patient Alliance for Health & Safety (PPAHS)