Preventing Opioid-induced Respiratory Depression in Med-Surg Though the Use of Capnography

Purpose:
Opioid-induced respiratory depression (OIRD) is a life-threatening complication of opioid analgesia. This quality improvement project aimed to decrease the incidence of OIRD by increasing the use of capnography on medical-surgical units, thereby improving patient safety.

Significance:
Failure to recognize OIRD may result in respiratory arrest, anoxic brain injury, and death. Capnography has been shown to detect early signs of OIRD. Early detection facilitates the timely rescue of patients on medical-surgical units where critical patient events are less likely to be witnessed.

Strategy and Implementation:
The innovation consisted of a multifaceted intervention to improve the identification of patients at risk for OIRD and to measure their end-tidal carbon dioxide with portable continuous capnography monitors. The intervention included: 1) an updated nursing protocol, 2) an electronic order trigger for physicians and nurses to assess patient risk factors for OIRD, 3) improved access to portable capnography monitors, and 4) education to staff about risk factors for OIRD and the appropriate use of capnography. The project was conducted over twelve months on ten medical-surgical units at a 489-bed academic medical center in Southern Arizona. Outcomes were measured using pre- and post-intervention point prevalence surveys. Indicators included the number of patients being monitored with capnography and the number of cases of OIRD. A survey of medical-surgical RNs was also conducted to gather their perceptions on the ease of use and effectiveness of capnography.

Evaluation:
The intervention succeeded in increasing the use of capnography by a statistically significant amount, though the increased monitoring did not significantly reduce the incidence of OIRD. RNs perceived capnography as easy to use, but reported difficulties with supply and patient adherence.

Implications for Practice:
Capnography is a useful tool for detecting OIRD, but determining whom to monitor based on patient risk factors for OIRD remains challenging. The RN survey highlighted areas in need of further improvement, such as the supply of monitors and patient education.