Reducing Opioid Induced Respiratory Depression in Post-Operative Arthroplasty Patients

Document Type

Conference Proceeding

Publication Date

5-1-2021

Publication Title

Anesth Analg

Abstract

INTRODUCTION: Pain management in post-operative hospitalized patients often involves the use of opioids and other potential sedating medications. However, with an aging population accompanied by increasing co-morbidities, there is growing concern for opioid induced respiratory depression (OIRD). In hospitalized patients, OIRD is cited as a major cause of preventable adverse events. There is lack of consensus on how to identify patients at risk and which monitoring modalities are most effective at reducing this risk. Several tools have been suggested for identification of patients at high risk of developing OIRD, including Michigan Opioid Safety Score (MOSS) and Opioid Predictive Risk Assessment Tool (OPRAT), PRODIGY score. Based on our own Henry Ford Health System (HFHS) data as well as literature review, we modified the existing OPRAT into the HFHS OPRAT tool which we believe is more clinically applicable. Our study aimed to compare two clinical tools on their efficacy in predicting opioid induced respiratory depression (OIRD), as well as to determine whether our remote monitoring strategy reduces naloxone usage which serves as a marker for OIRD. METHODS: Masimo SafetyNet system was implemented in October 2018 for post operative arthroplasty patients. Post-operative arthroplasty patients admitted to Henry Ford Main Hospital (HFH) in January - December 2019 were assigned a MOSS and a HFHS OPRAT score. Retrospective data analysis was performed from total joint arthroplasty patients at HFH during this time period. Based on literature review, an algorithm was established for post operative monitoring of patients using Masimo SafetyNet system. Patients with HFHS OPRAT score greater than 10 and requiring supplemental oxygen were considered high risk, therefore they are subjected to continuous pulse oximetry with either acoustic respiratory rate monitor or end-tidal carbon dioxide monitor. Data was collected from Masimo SafetyNet monitoring system and analyzed to see the predictability of risk assessment tools. OIRD was defined as RR<10 breaths/minute and oxygen saturation less than 82%. These values were set as cut off limits for alarms in the Masimo SafetyNet monitoring system. We also compared the rates of naloxone usage on arthroplasty patients with remote monitoring in place to a historical cohort (2017). RESULTS: There was significant reduction in naloxone use over one year study period when compared to historical cohort. Retrospective data analysis from Masimo SafetyNet monitoring system shows that the HFHS OPRAT score when compared with MOSS score has higher predictability of recognizing Opioid Induced Respiratory Depression. CONCLUSION: Upon analysis of data from naloxone administration after implementation of the Masimo Safety Net System, it is evident that remote monitoring system can help with early detection of OIRD, and it can be effective in other inpatient areas, and especially for post operative patients. HFHS OPRAT score has higher predictability of recognizing OIRD as compared to MOSS score. Further data analysis is in progress which includes, but not limited to the frequency of OIRD, types of alerts captured during the admission and prior to naloxone administration. Upon validation of HFHS OPRAT tool in other inpatient populations, goal is to utilize it for identifying high risk patients who can benefit for more intensive monitoring in the post operative period. (Figure Presented).

Volume

132

Issue

5

First Page

716

Last Page

717

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