From the Department of Anesthesiology.
Value Institute.
J Patient Saf. 2021 Dec 1;17(8):557-561. doi: 10.1097/PTS.0000000000000696.
The primary study objective was to investigate the impact of surveillance monitoring (i.e., continuous monitoring optimized for deterioration detection) on mortality and severe morbidity associated with administration of sedative/analgesic medications in the general care setting. A second objective was consideration of the results in the context of previous investigations to establish practice recommendations for this approach to patient safety.
Retrospective review of available rescue event and patient safety data from a tertiary care hospital in a rural setting was performed for a 10-year period. Systematic analysis of all adult general care inpatient data followed by chart review for individual patients was used to identify patient death or permanent harm (i.e., ventilator dependency, hypoxic encephalopathy) related to administration of sedative/analgesics.
Of 111,488 patients in units with surveillance monitoring available, none died or were harmed by opioid-induced respiratory depression when surveillance monitoring was in use. One patient died from opioid-induced respiratory depression in a unit where surveillance monitoring was available; however, the patient was not monitored at the time of the adverse event. In unmonitored units (15,209 patients during 29 months of incremental implementation), three patients died from opioid overdose (19.73 deaths per 100,000 at risk patients). The reduced death rate when surveillance monitoring was available (0.0009%) versus not available (0.02%) was significant (P = 0.03).
For a 10-year period, the rescue system with continuous surveillance monitoring had a profound effect on death from sedative/analgesic administration in the general care setting. This approach to patient safety can help address the risk of sedative/analgesic-related respiratory arrests in hospitals.
主要研究目的是调查监测（即，针对恶化检测进行优化的连续监测）对镇静/镇痛药物给药相关的一般护理环境中的死亡率和严重发病率的影响。第二个目的是考虑以前的研究结果，为这种患者安全方法建立实践建议。
对农村三级护理医院的可用抢救事件和患者安全数据进行了为期 10 年的回顾性审查。对所有成人普通护理住院患者数据进行系统分析，然后对个别患者进行病历审查，以确定与镇静/镇痛药物给药相关的患者死亡或永久性伤害（即呼吸机依赖、缺氧性脑病）。
在有监测监测的 111488 名患者中，当使用监测监测时，没有患者因阿片类药物引起的呼吸抑制而死亡或受到伤害。一名患者在有监测监测的病房中因阿片类药物引起的呼吸抑制而死亡；然而，在发生不良事件时，该患者未被监测。在未监测的病房（在 29 个月的增量实施中，有 15209 名患者）中，有 3 名患者死于阿片类药物过量（每 100000 名高危患者中有 19.73 人死亡）。当有监测监测时（0.0009%）与没有监测监测时（0.02%），死亡率降低具有统计学意义（P = 0.03）。
在 10 年期间，具有连续监测监测的抢救系统对一般护理环境中镇静/镇痛药物给药导致的死亡产生了深远影响。这种患者安全方法可以帮助解决医院中镇静/镇痛相关呼吸暂停的风险。
