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McNaughton MA, Lundberg J, Schenian M, Maynard L, Aplin A, Kautza-Farley A, Finch-Guthrie P. Nurses' Ability to Recognize and Prevent Opioid-Induced Respiratory Depression: An Evidenced-Based Practice Project. Orthop Nurs 2021; 40:345-351. [PMID: 34851876 DOI: 10.1097/nor.0000000000000805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Opioids are the primary therapy for acute postoperative pain, despite being associated with opioid-induced respiratory depression (OIRD). The purpose of this study was to improve nurses' knowledge, confidence, and ability to recognize, prevent, and treat OIRD in postoperative inpatients and evaluate the feasibility of using the Pasero Opioid-Induced Sedation Scale (POSS). Registered nurses completed three tools: (1) an Opioid Knowledge Self-Assessment, which was administered pre- and post-education; (2) a Confidence Scale, which was administered pre- and post-education; and (3) a POSS Perceptions and Usability Scale that was administered post-education. Nurses were educated on the POSS and then immediately following the training practiced by undertaking a patient assessment using the instrument. They then completed the POSS Perceptions and Usability Scale to rate their perception of the feasibility of using the POSS. Between preeducation and posteducation, participant knowledge increased in the following areas: recognizing opioid-induced side effects, dose selection, risk factors for oversedation, and information to make clinical decisions. However, there was a drop in scores when asked about knowledge of who is at risk for opioid-related side effects. These findings support our conclusion that OIRD education improves nursing confidence and knowledge. There was significant agreement between the nurse and subject matter experts POSS scores, indicating that this tool is easy to use.
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Affiliation(s)
- Molly A McNaughton
- Molly A. McNaughton, MAN, APRN, CNP-BC, RN-BC, AP-PMN , Abbott Northwestern Hospital, Minneapolis, MN
- Jamie Lundberg, BSN, RN, PHN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Meghan Schenian, BSN, RN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Leslie Maynard, MSN, BSN, RN-BC, APRN-BC , Abbott Northwestern Hospital, Minneapolis, MN
- Amanda Aplin, DNP, MAOL, RN, Abbott Northwestern Hospital, Minneapolis, MN; Student, St. Catherine University, St. Paul, MN
- Amanda Kautza-Farley, DNP, MAOL, RN , Student, St. Catherine University, St. Paul, MN
- Patricia Finch-Guthrie, PhD, RN , Faculty, St. Catherine University, St. Paul, MN
| | - Jamie Lundberg
- Molly A. McNaughton, MAN, APRN, CNP-BC, RN-BC, AP-PMN , Abbott Northwestern Hospital, Minneapolis, MN
- Jamie Lundberg, BSN, RN, PHN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Meghan Schenian, BSN, RN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Leslie Maynard, MSN, BSN, RN-BC, APRN-BC , Abbott Northwestern Hospital, Minneapolis, MN
- Amanda Aplin, DNP, MAOL, RN, Abbott Northwestern Hospital, Minneapolis, MN; Student, St. Catherine University, St. Paul, MN
- Amanda Kautza-Farley, DNP, MAOL, RN , Student, St. Catherine University, St. Paul, MN
- Patricia Finch-Guthrie, PhD, RN , Faculty, St. Catherine University, St. Paul, MN
| | - Meghan Schenian
- Molly A. McNaughton, MAN, APRN, CNP-BC, RN-BC, AP-PMN , Abbott Northwestern Hospital, Minneapolis, MN
- Jamie Lundberg, BSN, RN, PHN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Meghan Schenian, BSN, RN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Leslie Maynard, MSN, BSN, RN-BC, APRN-BC , Abbott Northwestern Hospital, Minneapolis, MN
- Amanda Aplin, DNP, MAOL, RN, Abbott Northwestern Hospital, Minneapolis, MN; Student, St. Catherine University, St. Paul, MN
- Amanda Kautza-Farley, DNP, MAOL, RN , Student, St. Catherine University, St. Paul, MN
- Patricia Finch-Guthrie, PhD, RN , Faculty, St. Catherine University, St. Paul, MN
| | - Leslie Maynard
- Molly A. McNaughton, MAN, APRN, CNP-BC, RN-BC, AP-PMN , Abbott Northwestern Hospital, Minneapolis, MN
- Jamie Lundberg, BSN, RN, PHN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Meghan Schenian, BSN, RN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Leslie Maynard, MSN, BSN, RN-BC, APRN-BC , Abbott Northwestern Hospital, Minneapolis, MN
- Amanda Aplin, DNP, MAOL, RN, Abbott Northwestern Hospital, Minneapolis, MN; Student, St. Catherine University, St. Paul, MN
- Amanda Kautza-Farley, DNP, MAOL, RN , Student, St. Catherine University, St. Paul, MN
- Patricia Finch-Guthrie, PhD, RN , Faculty, St. Catherine University, St. Paul, MN
| | - Amanda Aplin
- Molly A. McNaughton, MAN, APRN, CNP-BC, RN-BC, AP-PMN , Abbott Northwestern Hospital, Minneapolis, MN
- Jamie Lundberg, BSN, RN, PHN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Meghan Schenian, BSN, RN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Leslie Maynard, MSN, BSN, RN-BC, APRN-BC , Abbott Northwestern Hospital, Minneapolis, MN
- Amanda Aplin, DNP, MAOL, RN, Abbott Northwestern Hospital, Minneapolis, MN; Student, St. Catherine University, St. Paul, MN
- Amanda Kautza-Farley, DNP, MAOL, RN , Student, St. Catherine University, St. Paul, MN
- Patricia Finch-Guthrie, PhD, RN , Faculty, St. Catherine University, St. Paul, MN
| | - Amanda Kautza-Farley
- Molly A. McNaughton, MAN, APRN, CNP-BC, RN-BC, AP-PMN , Abbott Northwestern Hospital, Minneapolis, MN
- Jamie Lundberg, BSN, RN, PHN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Meghan Schenian, BSN, RN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Leslie Maynard, MSN, BSN, RN-BC, APRN-BC , Abbott Northwestern Hospital, Minneapolis, MN
- Amanda Aplin, DNP, MAOL, RN, Abbott Northwestern Hospital, Minneapolis, MN; Student, St. Catherine University, St. Paul, MN
- Amanda Kautza-Farley, DNP, MAOL, RN , Student, St. Catherine University, St. Paul, MN
- Patricia Finch-Guthrie, PhD, RN , Faculty, St. Catherine University, St. Paul, MN
| | - Patricia Finch-Guthrie
- Molly A. McNaughton, MAN, APRN, CNP-BC, RN-BC, AP-PMN , Abbott Northwestern Hospital, Minneapolis, MN
- Jamie Lundberg, BSN, RN, PHN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Meghan Schenian, BSN, RN , EBP Scholar, Abbott Northwestern Hospital, Minneapolis, MN
- Leslie Maynard, MSN, BSN, RN-BC, APRN-BC , Abbott Northwestern Hospital, Minneapolis, MN
- Amanda Aplin, DNP, MAOL, RN, Abbott Northwestern Hospital, Minneapolis, MN; Student, St. Catherine University, St. Paul, MN
- Amanda Kautza-Farley, DNP, MAOL, RN , Student, St. Catherine University, St. Paul, MN
- Patricia Finch-Guthrie, PhD, RN , Faculty, St. Catherine University, St. Paul, MN
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Levy N, Quinlan J, El-Boghdadly K, Fawcett WJ, Agarwal V, Bastable RB, Cox FJ, de Boer HD, Dowdy SC, Hattingh K, Knaggs RD, Mariano ER, Pelosi P, Scott MJ, Lobo DN, Macintyre PE. An international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients. Anaesthesia 2021; 76:520-536. [PMID: 33027841 DOI: 10.1111/anae.15262] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2020] [Indexed: 01/01/2023]
Abstract
This international multidisciplinary consensus statement was developed to provide balanced guidance on the safe peri-operative use of opioids in adults. An international panel of healthcare professionals evaluated the literature relating to postoperative opioid-related harm, including persistent postoperative opioid use; opioid-induced ventilatory impairment; non-medical opioid use; opioid diversion and dependence; and driving under the influence of prescription opioids. Recommended strategies to reduce harm include pre-operative assessment of the risk of persistent postoperative opioid use; use of an assessment of patient function rather than unidimensional pain scores alone to guide adequacy of analgesia; avoidance of long-acting (modified-release and transdermal patches) opioid formulations and combination analgesics; limiting the number of tablets prescribed at discharge; providing deprescribing advice; avoidance of automatic prescription refills; safe disposal of unused medicines; reducing the risk of opioid diversion; and better education of healthcare professionals, patients and carers. This consensus statement provides a framework for better prescribing practices that could help reduce the risk of postoperative opioid-related harm in adults.
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Affiliation(s)
- N Levy
- Department of Anaesthesia and Peri-operative Medicine, West Suffolk Hospital, Bury St. Edmunds, UK
| | - J Quinlan
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - W J Fawcett
- Department of Anaesthesia and Pain Medicine, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - V Agarwal
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - F J Cox
- Pain Management Service, Critical Care and Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - H D de Boer
- Department of Anaesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Groningen, The Netherlands
| | - S C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA
| | - K Hattingh
- Bendigo Health, Bendigo, Victoria, Australia
| | - R D Knaggs
- School of Pharmacy, Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - E R Mariano
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Anesthesiology and Peri-operative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - P Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy
| | - M J Scott
- Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
- David Greenfield Metabolic Physiology Unit, MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - P E Macintyre
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
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