Home Monitoring of Adult and Pediatric Patients on Opioids for Pain Post-Surgery

Abstract

Background: Opioid related deaths have been rapidly increasing and are a national focus1. Uintah Basin Medical Center is a 49-bed hospital located in eastern Utah. Following 3 unplanned home deaths in patients taking opioids post-operatively who had undergone ENT surgery, we sought to pilot a home monitoring protocol to earlier identify and intervene with patients most at risk for opioid induced respiratory depression (OIRD).

Methods: From February-July 2017, pediatric and adult patients prescribed opiates were discharged with a Masimo RAD 8 monitor for 7 days. Data was recorded and analyzed post device return. Pts were educated about the risks of opioid use, the relation between OIRD and falling blood oxygen levels (monitoring with a pulse oximeter) and instructed to call or come to the hospital if oxygen saturation alarmed (< 86%).

Results: Sixty-nine total patients were monitored. Results are reported in Table 1 below.

Conclusions: Some argue the addition of O₂ masks OSA episodes. At the time of our study, SpO₂ monitoring was an inexpensive and approved way to monitor for 'recurrent respiratory events'. It was our impression that using the Masimo technology would diminish false alerting. The FDA has since cleared the Masimo acoustic monitoring (RAM) for home use. We are performing a side-by-side study comparing SpO₂ with RAM home monitoring. With 66 (96%) of the pts studied being opioid naive, we agree with guidelines from the Centers for Disease Control and Prevention and other organizations which recommend short- acting opioids rather than long-acting or extended release opioids for acute pain in opioid naive pts. Factors such as age, gender, hepatic/renal impairment, comorbidities, benzodiazepine use and drug metabolism should be considered. More education to ED staff regarding protocol compliance is needed. We recognize relying on patients/caregivers to identify and respond to out of range parameters is not ideal. It is our impression that opioid related deaths are under diagnosed/reported. Our facility, with representatives from Intermountain Healthcare, have assisted Utah Senator Van Tassell in a resolution to raise awareness of the need for home monitoring. A news agency featured our collaborative efforts in multiple media platforms. More studies will be required before conclusions can be drawn; however, we support Respiratory Care Services as being in a unique position to perform impactful studies.