Nursing professor recruits WNY patients for study to improve patient safety with opioids

BUFFALO, N.Y. - An international study to develop a screening tool that hospital nurses can use to improve patient safety when administering opioid medications for acute pain included 130 patients at Buffalo General Medical Center.

The Buffalo site primary investigator was Carla Jungquist, PhD, associate professor and adult/gerontology program coordinator in UB’s School of Nursing.

Conclusions from the study data enabled the development of the PRODIGY risk prediction tool, an easy-to-use risk prediction scoring tool to identify patients at high risk of opioid-induced respiratory depression (OIRD) who might benefit from continuous monitoring with capnography and early intervention.

The screening tool developed by the study will be used to determine risks of respiratory depression when patients are given opioid pain medication. Opioids are effective medications for pain management, but can cause excessive sedation and respiratory depression resulting in patient harm, including death, according to Jungquist.

In the U.S., 50% of patients hospitalized will receive opioid medications to control acute pain, she says, and six out of every 1,000 postoperative patients receiving opioids will experience a serious adverse event.

The international study, sponsored by Medtronic medical technology company, recommended routine preoperative screening for known risk factors of postoperative OIRD with all surgical patients.

The study, which analyzed 1,335 patients across 16 sites in the United States, Europe and Asia, stated that respiratory depression, as defined by changes in pulse oximetry and capnography-monitoring parameters, occurred in 46% of medical and surgical patients evaluated who were receiving intravenous opioids for pain. This incidence rate is significantly higher than previously reported in clinical literature.

The complete study results are published online in Anesthesia and Analgesia, the journal of the International Anesthesia Research Society.

Jungquist was primary investigator for the Buffalo General site, overseeing the research and responsible for recruitment and procedures.

Jungquist said she would like to say “thank you” to all the patients that participated in this study. This is an important study that will improve patient safety, according to Jungquist.

“The reason I led the Buffalo site is because I know there is a significant problem,” said Jungquist. “I don’t want one more death or serious patient injury caused by opioid-induced respiratory depression.

“No one should see a loved one go into a hospital and die or be injured because they were given an opioid medication and the nurses did not recognize that they were at risk of an adverse event from respiratory depression.”

Patients need to know they were part of a study that has international importance for improving patient safety, said Jungquist, who has written a monograph for patient safety with opioid medications.

“This instrument will improve patient safety because it allows nurses to identify patients who were at higher risk from opioid medication,” she said.

Jungquist was the lead writer of the Association Society for Pain Management Nursing monitoring guidelines.

Despite recommendations from several professional and safety organizations as well as the recently published Guidelines from the American Society for Pain Management Nursing, currently, there are no universally accepted practices for effective and safe assessment and monitoring practices for patients receiving in-hospital intravenous opioid analgesia.

Most patients in hospitals around the world continue to be monitored on an intermittent spot-check basis as opposed to continuous electronic respiratory monitoring, thereby potentially missing large periods of dangerous respiratory depression.

“PRODIGY data confirms that respiratory depression in patients receiving parenteral opioids occur frequently and are potentially unknown to hospital health care providers,” said Ashish K. Khanna, primary study investigator and an associate professor of anesthesiology, section head for research and intensivist at the Wake Forest School of Medicine.

“Together with risk assessment using the PRODIGY risk score, the use of capnography and oximetry for continuous monitoring of patients identified as high risk for respiratory depression may increase safety when parenteral opioid analgesia cannot be avoided,” Khanna said.

The PRODIGY risk score uses five easy-to-access patient risk factors including: age, gender, opioid naïvety, sleep disorders and chronic heart disease for respiratory depression events risk prediction.