Published October 5, 2020
An international study to develop a screening tool that hospital nurses can use to improve patient safety when administering opioid medications for acute pain included 130 patients at Buffalo Medical Center.
The Buffalo site primary investigator was Carla Jungquist, associate professor and adult/gerontology program coordinator in the School of Nursing.
Conclusions from the study data enabled development of the PRODIGY risk preduction tool, an easy-to-use risk preduction scoring tool to identify patients at high risk of opioid-induced respiratory depression (OIRD) who might benefit from continuous monitoring with capnography and early intervention.
The screening tool developed by the study will be used to determine risks of respiratory depression when patients are given opioid pain medication. Opioids are effective medications for pain management, but can cause excessive sedation and respiratory depression resulting in patient harm, including death, Jungquist explains.
In the U.S., 50% of patients hospitalized will receive opioid medications to control acute pain, she says, and six out of every 1,000 postoperative patients receiving opioids will experience a serious adverse event.
The international study, sponsored by Medtronic medical technology company, recommended routine preoperative screening for known risk factors of postoperative OIRD with all surgical patients.
The study, which analyzed 1,335 patients across 16 sites in the United States, Europe and Asia, found that respiratory depression, as defined by changes in pulse oximetry and capnography-monitoring parameters, occurred in 46% of medical and surgical patients evaluated who were receiving intravenous opioids for pain. This incidence rate is significantly higher than previously reported in the clinical literature.
The complete study results are published online in Anesthesia and Analgesia, the journal of the International Anesthesia Research Society.
Jungquist was primary investigator for the Buffalo General site, overseeing the research and responsible for recruitment and procedures.
Jungquist says she would like to say “thank you” to all the patients that participated in the study, important research that will improve patient safety.
“The reason I led the Buffalo site is because I know there is a significant problem,” she says. “I don’t want one more death or serious patient injury caused by opioid-induced respiratory depression.
“No one should see a loved one go into a hospital and die or be injured because they were given an opioid medication and the nurses did not recognize that they were at risk of an adverse event from respiratory depression.”
Patients need to know they were part of a study that has international importance for improving patient safety, says Jungquist, who has written a monograph for patient safety with opioid medications.
“This instrument will improve patient safety because it allows nurses to identify patients who were at higher risk from opioid medication,” she says.
Jungquist was the lead writer of the Association Society for Pain Management Nursing monitoring guidelines.
Despite recommendations from several professional and safety organizations, as well as the recently published Guidelines from the American Society for Pain Management Nursing, there currently are no universally accepted practices for effective and safe assessment and monitoring practices for patients receiving in-hospital intravenous opioid analgesia.
Most patients in hospitals around the world continue to be monitored on an intermittent, spot-check basis as opposed to continuous electronic respiratory monitoring, thereby potentially missing large periods of dangerous respiratory depression.
“PRODIGY data confirms that respiratory depression in patients receiving parenteral opioids occurs frequently and is potentially unknown to hospital health care providers,” notes Ashish K. Khanna, primary study investigator and associate professor of anesthesiology, section head for research and intensivist at the Wake Forest School of Medicine.
“Together with risk assessment using the PRODIGY risk score, the use of capnography and oximetry for continuous monitoring of patients identified as high risk for respiratory depression may increase safety when parenteral opioid analgesia cannot be avoided,” Khanna says.
The PRODIGY risk score uses five easy-to-access patient risk factors, including age, gender, opioid naïvety, sleep disorders and chronic heart disease for respiratory depression events risk prediction.