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Henry Ford Health System


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). Despite this growing concern, there has not been an evidence based method to identify patients at risk for OIRD, nor ways to allocate monitoring modalities appropriately. Our aim is 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 We reviewed retrospective data from our own health system on naloxone use and based on these findings we modified the Opioid Predictive Risk Assessment Tool (OPRAT) into the HFHS OPRAT which we hypothesize is more predictive of patients at risk for OIRD than the Michigan Opioid Safety Score (MOSS) in use previously. Post operative arthroplasty patients admitted to Henry Ford Main Hospital in January - December 2019 will each be assigned a MOSS and a HFHS OPRAT score. Data will be reviewed retrospectively to determine which score is more predictive of OIRD. Patients receiving HFHS OPRAT more than 10 and requiring supplemental oxygen are considered high risk, therefore they would be subjective to continuous pulse oximetry with either acoustic respiratory rate monitor or end tidal carbon dioxide monitor. This cohort of patient in 2019 will be compared with a historical cohort in 2017 (before the introduction of remote acoustic respiratory rate monitoring) to evaluate if the current monitoring modality reduces naloxone usage.

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Reducing Opioid Induced Respiratory Depression in Post-Operative Arthroplasty Patients