Opioid Anagesia In Hospitalised Patients

For several considerable years, Joint Commission accreditation standards have emphasised patients’ right to have their pain properly assessed and managed. Healthcare providers have responded with an intensified focus on pain management, using pain medications. However, as the difficulty of analgesic therapies rises, establishment of priorities of care must be created in order to avert or diminish adverse events from occurring and to ensure that high quality and safe care is followed through. Opioid analgesia, in particular, remains to be the main primary pharmacologic intervention for managing pain in hospitalised patients. Among them are the common drugs fentanyl and morphine.

However, while opioid use is generally safe for most patients,

In support of this statement, a British study of 3,695 of adverse drug reactions from hospitalised patients concluded that a staggering 16% were attributed to opioids alone, making opioids one of the most associated drugs in adverse reactions. Indeed, the incidence of respiratory depression among post-operative patients was reported to average about 9.5% (Cravero et al. 2006). In general, some of the causes for adverse events associated with opioid use are simply due to a lack of knowledge about the potency differences among opioid analgesics. As well as that is the improper prescribing and administration of multiple opioids (i.e., oral, parenteral or transdermal patches). But more importantly, it is due to inadequate monitoring of patients on opioids (The Joint Commission,

The case illustrates a twenty-nine year old postsurgical patient following a vaginal hysterectomy. She received a mixture of Demerol and Emetecon in a patient-controlled analgesia solution. She was then found cold, blue, unresponsive and dead after the night nurse last checked her vital signs two hours before her death at midnight. Post-mortem toxicology levels revealed severely toxic amounts of Demerol.

Upon examination, one would realise that this was a case that could have easily been preventable. While these types of drugs are known to depress respiratory effort, situations like this unfortunately occur with great rate, especially in critical care units where opiate narcotics and benzodiazepine sedatives are daily drugs in clinical practice. These types of drugs require special diligence and awareness by the nurse to guarantee safe