Center for Health Care Improvement and Research Institute Outcomes Department, Anne Arundel Medical Center, Annapolis, MD.
Department of Pharmacy, Anne Arundel Medical Center, Annapolis, MD.
Am J Health Syst Pharm. 2017 Feb 1;74(3):162-169. doi: 10.2146/ajhp160208. Epub 2016 Dec 19.
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.
报告了为减轻阿片类药物引起的过度镇静和呼吸抑制（OSRD）的原因而实施的干预措施。
对合格的纳洛酮抢救病例进行了单站点回顾性研究，以确定医院中阿片类药物引起的 OSRD 的原因，并确定风险因素。使用问卷调查评估医院内科医生处方者潜在的阿片类药物知识缺陷。根据病例回顾的结果和阿片类药物知识评估的结果，在随后的几个月中实施了一系列干预措施，以解决发现的缺陷，包括加强镇静监测、改进电子病历中的临床决策支持，以及对高风险患者的剂量进行各种调整。我们分析的主要终点是纳洛酮用于记录的阿片类药物引起的 OSRD 病例，以确定干预措施的有效性。在实施干预措施之前，每季度平均发生 16 例 OSRD 事件。在 OSRD 病例中发现了平均五个风险因素（范围为两个至六个），最常见的是年龄>60 岁、肥胖和肾脏及肺部合并症。在四个相互关联的领域发现了临床护理缺陷：知识缺陷、监测不足、未能利用电子病历以及关于疼痛评估和镇静管理的文化问题。
在急症医院实施了一整套解决方案，利用电子病历创建有意义的临床决策支持，并针对疼痛目标和镇静水平沟通进行文化变革，这导致 OSRD 事件减少了五倍，并且已经持续了两年。
