Original ArticleAmerican Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Sedation and Respiratory Depression
Section snippets
Background
Effective pain management is a priority of care and a patient right (Joint Commission, 2010). Advances in pain science justify the need for more aggressive pain therapies to reduce pain severity and the likelihood for both short- and long-term consequences of unrelieved pain (Basbaum, Bautista, Scherrer, & Julius, 2009; Carr & Goudas, 1999; Latremoliere and Woolf, 2009, Woolf and Salter, 2000). Multimodal analgesia, which combines analgesics with variable pharmacodynamics to target multiple
Methodology
For this review, the definition of “monitoring” is the practice of using nurse observations of sedation and respiration including but not limited to the use of sedation assessment scales and technologies to collect serial measurements to anticipate and recognize unintended advancing sedation or respiratory depression. There was early agreement among panel members that the search and appraisal of scientific literature and formulation of recommendations should focus primarily on adult
Statement of Conditions
This report is aligned with ASPMN’s mission and goals to promote optimal nursing care for people affected by pain through best nursing practices, education, standards, advocacy, and research. (http://aspmn.org/) The ASPMN Expert Consensus Panel on Monitoring for Opioid-Induced Sedation and Respiratory Depression recommendations serve as a guide for developing and implementing safe and effective plans of care, facilitating systems-level changes to support safe and effective patient care, and
Definition
Individual risks are defined as factors that predispose a person to unintended opioid-induced advancing sedation and respiratory depression. These factors include but are not limited to age, anatomic anomalies, physical characteristics, primary and comorbid medical conditions, psychologic states, and functional status. Identification of patients at risk for adverse events when opioid analgesics are administered for pain management is a critical consideration when developing plans of care to
Definition
Iatrogenic risks are defined as pain therapy–related variables, environmental factors, and circumstances in the hospital workplace that may predispose a patient to increased risk for unintended advancing sedation or respiratory depression. Methods of opioid administration and nurse practice variables, such as staffing and communication, are of greatest concern.
Search Strategies
Three separate searches of Medline and PubMed databases were performed to identify relevant publications in the past 20 years. Searches
Definition
For the present review, pharmacology is defined as pharmacologic agents that are administered for the treatment of pain in the acute care setting.
Search Strategies
Medline and the Cochrane Collaboration databases were searched for relevant publications of research with limits for age (>19 years), English language, and human studies from 1990 to year end 2009. MeSH terms used included: opioid, opioid analgesics, morphine, hydromorphone, fentanyl, oxycodone, respiratory depression, sedation, opioid-induced
Definition
The ASPMN’s definition of “monitoring” is the practice of using nurse observations including, but not limited to, the use of sedation assessment scales and technologies to collect serial measurements to anticipate and recognize advancing sedation or respiratory depression.
Search Strategies
A substantial review of the literature was conducted in PubMed and CINAHL to identify relevant research and clinical articles defining the practice of monitoring for patients receiving opioid analgesics for pain management.
Summary
To coincide with the mission of the ASPMN “to advance and promote optimal nursing care for people affected by pain by promoting best nursing practice,” clinical practice guidelines have been developed for monitoring patients at risk of advancing sedation and respiratory depression with opioid analgesia. This report has been executed with methodologies that include scientific rigor in the appraisal and summary of evidence and consensus building in the formulation of recommendations that focus on
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