The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

INTEGRAL ROLE OF RESPIRATORY THERAPISTS IN A COMPREHENSIVE PAIN MANAGEMENT PROGRAM USING END TIDAL CO2 MONITORING.

Debra Fox1, Mark Wencel2; 1Respiratory Care, Wesley Medical Center, Wichita, KS; 2Wichita Clinic, Wichita, KS

BACKGROUND: A hospital-wide conversion to a new "smart" infusion pump system including capnography provided an opportunity to develop a comprehensive program to safely and effectively manage pain. Effective pain management is vital to patient satisfaction. Patient monitoring with end-tidal CO2 (ETCO2) is essential in reducing adverse events and preventing respiratory depression from pain medication overdose. METHOD: A multidisciplinary team of Respiratory Therapists (RT), Nursing, Pharmacists, and Physicians developed policies and procedures for the new system. The components of the program included utilizing the "smart" pump technology to prevent medication administration errors, identifying high risk patients using a modified STOP/BANG scoring, and providing ET CO2 monitoring for all patients receiving patient controlled analgesia (PCA) therapy and all high risk patients receiving intermittent intravenous opioids. Staff education for Nursing and RTs regarding patient monitoring focused on ETCO2 technology and patient assessment. Nursing response to alarm situations is to notify RT and work together to follow established protocols for clinical interventions. The importance of collaboration between the bedside nurse and RT is emphasized with shared responsibilities for the initiation of monitoring, frequency of checks, and its use with oxygen and CPAP/BiPAP devices. Educating the patient about the reasons for monitoring is critical in acceptance of the ETCO2 device. The impact of ETCO2 monitoring in preventing respiratory depression was measured by the number of adverse drug events related to PCA and opioid pain medications and the use of opioid reversal agent Naloxone. RESULTS: Comparison of the reported adverse drug events from different time periods are displayed in the table below. The data show a shift from severe (life-threatening) events to the mild (naloxone reversal) and moderate (multiple naloxone reversals or other intervention required) categories. This shift may be attributed to earlier recognition of respiratory depression and intervening before the patient progresses to a life-threatening event. CONCLUSIONS: Respiratory therapists play a central role in the implementation and success of a comprehensive, hospital-wide program of pain management. The use of end-tidal CO2 monitoring is an effective method for early detection of respiratory depression in patients receiving PCA and intermittent IV opioid pain medication
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