ORIGINAL ARTICLE
Naloxone Triggering the RRT: A Human Antidote? Faheem W. Guirgis, MD,* Cynthia Gerdik, RN, MBA,Þ Robert L. Wears, MD, MS, PhD,* Colleen J. Kalynych, MSH, EdD,* Joseph Sabato, MD,* and Steven A. Godwin, MD*
Objectives: At our institution, we observed an increase in opioid-related adverse events after instituting a new pain treatment protocol. To prevent this, we programmed the Omnicell drug dispensing system to page the RRT whenever naloxone was withdrawn on the general wards. Methods: Retrospective review of a prospectively collected database with a before and after design. Results: When comparing the two 12-month periods, there was a decrease in monthly opioid-related cardiac arrests from 0.75 to 0.25 per month (difference = 0.5; 95% CI, 0.04Y0.96, P = 0.03) and a nearly significant decrease in code deaths from 0.25 to 0 per month (difference = j0.25; 95% CI, j0.02Y0.52, P = 0.07) without a significant decrease in pain satisfaction scores (difference = j2.3; 95% CI, j4.4 to 9.0, P = 0.48) over the study period. There were also decreased RRT interventions from 7.3 to 5.6 per month (difference = j1.7; 95% CI, j0.31 to j3.03, P = 0.02) and decreased inpatient transfers from 2.9 to 1.8 transfers per month (difference = j1.2; 95% CI, j0.38 to j1.96, P = 0.005). When adjusting for inpatient admissions and inpatient days, there was a decrease in opioid-related cardiac arrests from 2.9 to 0.1 per 10,000 admissions (difference = j2.0; 95% CI, j0.2 to j3.8, P = 0.03) and a decrease in cardiac arrests from 0.5 to 0.2 per 10,000 patients (difference = j0.34; 95% CI, j.02 to j0.65, P = 0.04). Conclusion: Naloxone-triggered activation of the RRT resulted in reduced opioid-related inpatient cardiac arrests without adversely affecting pain satisfaction scores. Key Words: opioid-induced respiratory depression, rapid response teams, in-hospital cardiac arrest, medical emergency teams, respiratory arrest (J Patient Saf 2014;00: 00Y00)
BACKGROUND AND INTRODUCTION The effective treatment of pain is of increasing concern across all health-care settings. The Joint Commission on Accreditation of Healthcare Associations has made the assessment and effective treatment of pain one of their pain management standards since 2001.1 Inadequate pain treatment may result in progression to chronic pain, immunosuppression, and longer hospital stays as well as increased mortality.2Y4 One of the most common classes of medications used for acute pain treatment is the opioid analgesics.5 Opioid analgesics are effective at treating pain across many health-care settings but have several side effects, which include nausea, vomiting, constipation, pruritus, respiratory depression, and sedation. The most severe consequences of opioid use are From the *Department of Emergency Medicine, and †Director of Critical Care Nursing, University of Florida and Shands Jacksonville Medical Center, Jacksonville, Florida. Correspondence: Faheem Wagid Guirgis, MD, 655 West 8th Street, Jacksonville, FL 32209 (e
Naloxone Triggering the RRT: A Human Antidote? Faheem W. Guirgis, MD,* Cynthia Gerdik, RN, MBA,Þ Robert L. Wears, MD, MS, PhD,* Colleen J. Kalynych, MSH, EdD,* Joseph Sabato, MD,* and Steven A. Godwin, MD*
Objectives: At our institution, we observed an increase in opioid-related adverse events after instituting a new pain treatment protocol. To prevent this, we programmed the Omnicell drug dispensing system to page the RRT whenever naloxone was withdrawn on the general wards. Methods: Retrospective review of a prospectively collected database with a before and after design. Results: When comparing the two 12-month periods, there was a decrease in monthly opioid-related cardiac arrests from 0.75 to 0.25 per month (difference = 0.5; 95% CI, 0.04Y0.96, P = 0.03) and a nearly significant decrease in code deaths from 0.25 to 0 per month (difference = j0.25; 95% CI, j0.02Y0.52, P = 0.07) without a significant decrease in pain satisfaction scores (difference = j2.3; 95% CI, j4.4 to 9.0, P = 0.48) over the study period. There were also decreased RRT interventions from 7.3 to 5.6 per month (difference = j1.7; 95% CI, j0.31 to j3.03, P = 0.02) and decreased inpatient transfers from 2.9 to 1.8 transfers per month (difference = j1.2; 95% CI, j0.38 to j1.96, P = 0.005). When adjusting for inpatient admissions and inpatient days, there was a decrease in opioid-related cardiac arrests from 2.9 to 0.1 per 10,000 admissions (difference = j2.0; 95% CI, j0.2 to j3.8, P = 0.03) and a decrease in cardiac arrests from 0.5 to 0.2 per 10,000 patients (difference = j0.34; 95% CI, j.02 to j0.65, P = 0.04). Conclusion: Naloxone-triggered activation of the RRT resulted in reduced opioid-related inpatient cardiac arrests without adversely affecting pain satisfaction scores. Key Words: opioid-induced respiratory depression, rapid response teams, in-hospital cardiac arrest, medical emergency teams, respiratory arrest (J Patient Saf 2014;00: 00Y00)
BACKGROUND AND INTRODUCTION The effective treatment of pain is of increasing concern across all health-care settings. The Joint Commission on Accreditation of Healthcare Associations has made the assessment and effective treatment of pain one of their pain management standards since 2001.1 Inadequate pain treatment may result in progression to chronic pain, immunosuppression, and longer hospital stays as well as increased mortality.2Y4 One of the most common classes of medications used for acute pain treatment is the opioid analgesics.5 Opioid analgesics are effective at treating pain across many health-care settings but have several side effects, which include nausea, vomiting, constipation, pruritus, respiratory depression, and sedation. The most severe consequences of opioid use are From the *Department of Emergency Medicine, and †Director of Critical Care Nursing, University of Florida and Shands Jacksonville Medical Center, Jacksonville, Florida. Correspondence: Faheem Wagid Guirgis, MD, 655 West 8th Street, Jacksonville, FL 32209 (e
