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Implementing a Clinical Practice Guideline on Opioid-Induced Advancing Sedation and Respiratory Depression
Josephine Kamendat1, Beverly W Dabney, Marilyn McFarland
1Wound Care/Family Practice, McLaren Port Huron/Lighthouse Family Medicine, Port Huron, Michigan (Dr Kamendat); University of Michigan-Flint School of Nursing, Flint, Michigan (Drs Dabney and McFarland); ∑igma∑tats® Consulting, LLC, Charleston, South Carolina (Dr Gilbert); and Education, Outpatient Services, and Informatics, McLaren Port Huron, Port Huron, Michigan (Ms Richards-Weatherby).
Background:
Opioid-induced respiratory depression (OIRD) is a serious adverse reaction associated with opioid administration.
Local Problem:
The purpose of this quality improvement study was to evaluate the impact of implementing a clinical practice guideline for OIRD in a medical-surgical setting lacking standardized monitoring techniques and reporting criteria for patients receiving opioid analgesia.
Methods:
An American Society for Pain Management Nursing protocol was implemented in 4 medical/surgical units. The impact on OIRD-related nurse knowledge, documentation, and opioid-related rapid response calls was measured pre- and postimplementation.
Results:
Nurse OIRD-related knowledge significantly increased. The number of naloxone administrations associated with prior intravenous opioid analgesic administration did not significantly change. However, there was a significant decrease in the postimplementation number of respiratory distress-related rapid response calls.
Conclusions:
Implementation of the American Society for Pain Management Nursing guidelines had a positive impact on knowledge, documentation, early intervention of OIRD, and the number of opioid-related rapid response calls.
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