The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Pamela Pohlenz, Karen Woodward, Linda Rosacker, Barb Nickel; St. Francis Medical Center, Grand Island, NE

DESCRIPTIVE OVERVIEW: Capnography Quality Improvement Process-2009 Adverse Drug Events reviewed in January 2010: Breakdown on Narcotic Patient Controlled Analgesia (PCA)events. Multidisciplinary group examined processes: Anesthesia recommendation to use capnography on inpatients.Literature review of capnography supports patient safety. PCA orders revised to include capnography in risk stratified population. Respiratory Care budgeted for 25 oximetry/capnography machines. Full Process reviewed with staff and implemented June/July. Post implementation data supports impact in reduction of narcotic reversal. METHODOLOGY: 2010: January-Pharmacy breakdown of 2009 Narcotic Reversals: PCA delivery involved in 50% of reversals.Nursing Peer Review: Respiratory suppression with PCA narcotic, above data included. Spring-Literature Search for Evidenced Based Practices: ETCO2 monitoring found to be earlier predictor of patient respiratory compromise than oximetry. Endorsement: from Anesthesia to monitor capnography on high risk patients. Cost Benefit Analysis:presented by Respiratory to Administrative Team for purchase of additional 25 multipurpose Capnography monitors based on PCA and Oximetry use. June-PCA Order Sets revised to include risk stratified indicators for Oximetry and ETCO2 monitoring. Staff Education & Competency. July-Order Sets made LIVE. Sept-Reinforcement of Nursing Education:at annual Skills Fair, including simulation. July to December-Quality Measures: Process monitored by Respiratory and Nursing. Adjustments made as needed. Narcotic reversal monitored by Pharmacy with data reported to Quality Councils. OUTCOMES: 40% reduction in reversal of PCA narcotics. 100% reduction in transfers to higher level of care for respiratory suppression with PCA narcotics. LESSONS LEARNED: Nurse Education: Increased understanding of intrapulmonary gas mixing & ventilation/perfusion relationship throughout clinical staff curriculum. Consider risk of desensitization to alarms:collaboration to reduce alarms. Continue to coach regarding process improvement: requires continual mentoring and monitoring of process and outcomes. Share success with staff: to continue to motivate toward culture of change and patient safety. CONCLUSION: More complete clinical picture of patient's respiratory status.Increased awareness of respiratory suppression and concomitant narcotic use. HCAHPS pain scores have remained stable with a 2% average increase. Process has been so widely used that we need more capnography machines.
Sponsored Research - None
Narcotic Reversal in 2009