Healthcare News & Insights

Respiratory depression: Another reason for hospitals to control opioid use

Hospitals have been called upon to reduce their opioid use with patients for several reasons. While controlling the opioid addiction epidemic has been getting the most attention, there are other reasons why facilities should be more careful with prescribing opioids – especially since their use could put patients’ lives in danger during a hospital stay. 

gettyimages-512142512Opioids can be essential for managing hospital patients’ pain in some cases. But they also contribute to a problem causing them to die suddenly: respiratory depression.

How it happens

According to an article from Medscape, opioids affect the parts of the brain that control respiration, causing patients to have difficulty breathing. The resulting lack of oxygen in the body from this respiratory depression can lead to cardiac arrest or brain damage.

Respiratory depression caused by powerful pain medication isn’t always talked about (or reported as an adverse event), but it’s a significant problem that’s only become more common in hospitals as opioid use has increased.

An in-depth investigative reporting piece by Ohio media outlet News 5 Cleveland sheds light on the extent of the issue. The article discusses several instances where hospital patients were found “dead in bed” due to respiratory depression. All were receiving opioid medications.

Risk factors

Specific factors put patients at higher risk of experiencing respiratory depression, such as suffering from sleep apnea. In some cases, patients who have undiagnosed sleep apnea end up dying from respiratory depression because hospitals weren’t aware of any pre-existing problems.

There are other contributing factors, however, that are more in a facility’s control. Prescribing practices are a major risk factor. Providers may be prescribing opioids that are too strong for the patient’s level of pain, or they may be inadvertently prescribing multiple opioids.

Importance of monitoring

Respiratory depression isn’t always noticed right away, especially in patients who have just had surgery. Here’s why: Most hospitals don’t routinely monitor all patients who are given opioids for signs of respiratory depression.

Facilities usually only monitor patients continuously for signs of respiratory depression on a case-by-case basis, depending on their current health condition. In some cases, even patients diagnosed with sleep apnea aren’t monitored as closely as recommended.

Regular pulse oximetry tests would help providers determine whether oxygen levels in patients’ bloodstreams have dropped to dangerous levels, so they could keep patients from experiencing any long-lasting harm.

Various organizations, including the Joint Commission and the Anesthesia Patient Safety Foundation, have called for hospitals to continuously monitor all patients via pulse oximetry to catch respiratory depression right away. In fact, research by the Joint Commission found that almost 30% of adverse events related to opioids were related to improper patient monitoring.

Healthcare experts acknowledge that making monitoring more common has the potential to prevent respiratory issues in patients who are taking opioids. It can also prevent costly malpractice lawsuits involving wrongful death in patients.

With that in mind, if your hospital isn’t already continuously monitoring patients taking opioids via pulse oximetry or using another tactic, you may want to start doing so. Looking into how feasible it is for your facility to continuously monitor patients for signs of respiratory depression is a smart decision that’ll likely improve patient outcomes.

Another good idea: Remind clinical staff of the importance of using smart prescribing practices when dispensing opioids, including alternative methods for pain management.


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