2005 OPEN FORUM Abstracts
EVALUATION OF A POST-OPERATIVE RESPIRATORY THERAPY ASSESSMENT PROTOCOL FOR THE PREVENTION OF NARCOTIC INDUCED COMPLICATIONS
P. Luehrs RRT BSRT BSEd. V. Hockensmith RN BSN CPHQ; S. Hiller RN BSN CCRN CPAN CoxHealth, Spfd. MO
Background: Narcotics are commonly administered after surgery for pain management. Well-known side effects of narcotic administration are sedation and respiratory depression, which can lead to injurious results. Hypoxemia and/or hypercapnia may ensue. This clinical scenario with its attendant complications can lead to severe complications including death. Certain preexisting conditions can increase a patient's probability for developing complications during post-op narcotic administration. Post Anesthesia Care Unit (PACU) staff and Respiratory Care Services created an assessment protocol that would follow patients from the immediate post-operative period through transfer to the floor. PACU staff would obtain a referral for the Post-Op Respiratory Therapy Assess and Treat Protocol based on a screening of specific criteria.
Method: The Post-Op Respiratory Therapy Assess and Treat Protocol has been designed to capture those patients recovering from surgery who may experience post-operative atelectasis, narcotic-induced hypoventilation, pre-existing obstructive sleep apnea syndrome (OSAS) and/or obesity hypoventilation syndrome (OHS). Using the following criteria patients are identified in the PACU and a physician's order to refer the patient for the Post-Op Respiratory Therapy Assess and Treat Protocol is obtained. Once the patient is on the Med-Surg unit Nursing and Respiratory Therapy Staff monitor the patient's pain level, sedation level, (using the Riker scale), and respiratory function to quantify the individual patient's risk for complications arising from narcotic administration. The criteria for obtaining the referral for Post-Op Respiratory Therapy Assess and Treat Protocol include: post-op oxygen requirements, BMI, age, pre-operative diagnosis of OSAS/OHS/COPD, oxygen home therapy, end stage organ failure, and ventilatory status. Based on this assessment the clinician can tailor the patient's treatment towards their specific complication with the goal of restoring adequate oxygenation and ventilation. An extensive chart review was conducted on all patients who required narcotic reversal with naloxone hydrochloride. A chart review was again done during the same time frame the following year.
Results: Looking at data from 2003 and 2004 we have reduced the number of respiratory arrests in adult patients receiving narcotics on medical-surgical units by 48%. Of the patients receiving a Respiratory Therapy assessment 10% received hyperinflation therapy, 5% received noninvasive ventilation and 3% received intubation and mechanical ventilation as a preventative strategy.
The development and implementation of the Post-Op Respiratory Therapy Assess and Treat Protocol has been a successful part of a multidisciplinary approach to preventing respiratory complications associated with narcotic administration. We recommend all institutions undertake a system by which a multidisciplinary team can assess a patient's risk for post-operative complications resulting from narcotic administration lead by the physician/respiratory therapist/ nurse team.