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Promoting the Use of Capnography in Acute Care Settings: An Evidence-Based Practice Project

      Opioid-induced respiratory depression (OIRD) is a life-threatening complication of opioid analgesia. End-tidal carbon dioxide monitoring (capnography) has been shown to detect early signs of OIRD earlier than other commonly used monitoring methods. The goal of this evidence-based practice project was to promote the standardized use of capnography to reduce the incidence of OIRD. The project included an updated nursing protocol, an electronic order trigger, improved access to capnography monitors, and staff education about OIRD risk assessment and the use of capnography. A survey of registered nurses was also conducted to gather their perceptions on the ease of use and effectiveness of capnography. Twelve months after introducing the intervention there was an increase in monitoring frequency, with 2.56 times more patients at high risk for OIRD being monitored with capnography than at baseline. Of the 171 registered nurses surveyed during this project, 99% perceived the portable capnography monitors as easy to use and interpret. However, 71% reported systems issues in obtaining the monitoring equipment, and 65% reported problems with patient adherence. The intervention succeeded in increasing the number of high-risk patients being monitored with capnography and reducing the number of cases of OIRD.

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      References

        • Weinger M.B.
        • Lee L.A.
        No patient shall be harmed by opioid-induced respiratory depression. Proceedings of “Essential Monitoring Strategies to Detect Clinically Significant Drug-Induced Respiratory Depression in the Postoperative Period” Conference.
        APSF Newsletter. 2011; 26: 21-40
        • Jarzyna D.
        • Jungquist C.
        • Pasero C.
        • et al.
        American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression.
        Pain Manag Nurs. 2011; 12: 118-145
        • ASPAN US PR Strategic Work Team
        The ASPAN prevention of unwanted sedation in the adult patient evidence-based practice recommendation.
        J Perianesth Nurs. 2014; 29: 344-353
        • Whitaker D.K.
        Time for capnography—Everywhere.
        Anaesthesia. 2011; 66: 544-549
        • Kodali B.S.
        Capnography outside the operating rooms.
        Anesthesiology. 2013; 118: 192-201
        • Overdyk F.
        • Guerra J.J.
        Improving outcomes in med-surg patients with opioid induced respiratory depression.
        Am Nurse Today. 2011; 6: 26-30
        • Odom-Forren J.
        Capnography and sedation: A global initiative.
        J Perianesth Nurs. 2011; 26: 221-224
      1. Promise to Amanda Foundation. About the promise to Amanda Foundation. 2012. Available at: http://promisetoamanda.org. Accessed November 2, 2014.

      2. Physician-Patient Alliance for Health & Safety. Capnography. 2013. Available at: http://ppahs.org/category/patient-monitoring/capnography/. Accessed November 14, 2014.

        • Oderda G.M.
        • Said Q.
        • Evans R.S.
        • et al.
        Opioid-related adverse drug events in surgical hospitalizations: Impact on costs and length of stay.
        Ann Pharmacother. 2007; 41: 400-407
        • Oderda G.
        • Gan T.J.
        • Johnson B.H.
        • Robinson S.B.
        Effect of opioid-related adverse events on outcomes in selected surgical patients.
        J Pain Palliat Care Pharmacother. 2013; 27: 62-70
        • Dahan A.
        • Aarts L.
        • Smith T.W.
        Incidence, reversal, and prevention of opioid-induced respiratory depression.
        Anesthesiology. 2010; 112: 226-238
      3. Institute for Safe Medication Practices. Pain scales don't weigh every risk. 2012:1-2. Available at: http://wwwismporg/Newslettersacutecare/articles/20020724asp. Accessed November 14, 2014.

        • Carlisle H.
        Implementing a Clinical Practice Guideline on the Use of Capnography in Monitoring for Opioid-Induced Respiratory Depression on Medical-Surgical Units [DNP Practice Inquiry].
        University of Arizona, Tucson, AZ2013
        • Overdyk F.
        • DeVita M.A.
        • Pasero C.
        Postoperative opioid-induced respiratory depression: Current challenges and new developments in patient monitoring.
        Anesthesiology News. 2012; : 1-8
        • Pasero C.
        The perianesthesia nurse's role in the prevention of opioid-related sentinel events.
        J Perianesth Nurs. 2013; 28: 31-37
        • The Joint Commission
        Safe use of opioids in hospitals.
        Sentinel Event Alert. 2012; 49: 1-5
        • Carlisle H.
        The case for capnography in patients receiving opioids.
        Am Nurse Today. 2014; 9: 22-27
        • Willens J.
        • Jungquist C.
        • Cohen A.
        • Polomano R.
        ASPMN survey—nurses' practice patterns related to monitoring and preventing respiratory depression.
        Pain Manag Nurs. 2013; 14: 60-65
        • Clifford T.
        Capnography for patient ventilatory status.
        J Perianesth Nurs. 2012; 27: 293-294
        • Langhan M.L.
        • Kurtz J.C.
        • Schaeffer P.
        • Asnes A.G.
        • Riera A.
        Experiences with capnography in acute care settings: Mixed-methods analysis of clinical staff.
        J Crit Care. 2014; 29: 1035-1040

      Biography

      Heather Carlisle, PhD, DNP, RN-BC, AGACNP-BC, FNP-BC, is a Clinical Assistant Professor of Nursing at the University of Arizona and an Adult-Gerontology Acute Care Nurse Practitioner, Tucson, AZ