Implementing a Clinical Practice Guideline on the Use of Capnography in Monitoring for Opioid-Induced Respiratory Depression on Medical-Surgical Units

Persistent Link:
http://hdl.handle.net/10150/293641
Title:
Implementing a Clinical Practice Guideline on the Use of Capnography in Monitoring for Opioid-Induced Respiratory Depression on Medical-Surgical Units
Author:
Carlisle, Heather Lynn
Issue Date:
2013
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
Background: Opioid-induced respiratory depression (OIRD) is a life-threatening complication of opioid analgesia. Failure to recognize and respond to OIRD may result in respiratory arrest, anoxic brain injury, and death. Measuring end-tidal carbon dioxide through the use of capnography has been shown to detect early signs of OIRD. Early detection of OIRD facilitates the timely rescue of patients on medical-surgical units where critical patient events are less likely to be witnessed. Purpose: The goal of this quality improvement project was to enhance patient safety by decreasing the incidence of OIRD. The aim was to design, implement, and evaluate a multifaceted intervention to improve patient monitoring for OIRD on medical-surgical units through the use of capnography. The intervention included an updated nursing protocol, an electronic order trigger, improved access to capnography monitors, and education to nurses about OIRD and the use of capnography. Methods: The project was conducted over twelve months on ten medical-surgical units at a 489-bed academic medical center in Southern Arizona. Outcomes were measured using pre- and post-intervention point prevalence surveys. Indicators included the number of patients being monitored with capnography and the number of cases of OIRD. A survey of medical-surgical RNs was also conducted to gather their perceptions on the ease of use and effectiveness of capnography. Results: Twelve months after introducing the intervention, there was a statistically significant increase in monitoring frequency, with 2.56 times more patients at high risk for OIRD being monitored with capnography than at baseline (p = .006). Of the 167 RNs 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. Preliminary data suggest that the incidence of OIRD decreased after one year, although not by a statistically significant amount (p = .876). Implications for Practice: The intervention succeeded in increasing the number of high-risk patients being monitored with capnography, though the increased monitoring did not improve patient outcomes. The RN survey highlighted areas in need of further improvement, such as the supply of monitors and patient education.
Type:
text; Electronic Dissertation
Keywords:
patient safety; quality improvement; respiratory depression; Nursing; pain management
Degree Name:
D.N.P.
Degree Level:
doctoral
Degree Program:
Graduate College; Nursing
Degree Grantor:
University of Arizona
Advisor:
Reel, Sally J.

Full metadata record

DC FieldValue Language
dc.language.isoenen_US
dc.titleImplementing a Clinical Practice Guideline on the Use of Capnography in Monitoring for Opioid-Induced Respiratory Depression on Medical-Surgical Unitsen_US
dc.creatorCarlisle, Heather Lynnen_US
dc.contributor.authorCarlisle, Heather Lynnen_US
dc.date.issued2013-
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractBackground: Opioid-induced respiratory depression (OIRD) is a life-threatening complication of opioid analgesia. Failure to recognize and respond to OIRD may result in respiratory arrest, anoxic brain injury, and death. Measuring end-tidal carbon dioxide through the use of capnography has been shown to detect early signs of OIRD. Early detection of OIRD facilitates the timely rescue of patients on medical-surgical units where critical patient events are less likely to be witnessed. Purpose: The goal of this quality improvement project was to enhance patient safety by decreasing the incidence of OIRD. The aim was to design, implement, and evaluate a multifaceted intervention to improve patient monitoring for OIRD on medical-surgical units through the use of capnography. The intervention included an updated nursing protocol, an electronic order trigger, improved access to capnography monitors, and education to nurses about OIRD and the use of capnography. Methods: The project was conducted over twelve months on ten medical-surgical units at a 489-bed academic medical center in Southern Arizona. Outcomes were measured using pre- and post-intervention point prevalence surveys. Indicators included the number of patients being monitored with capnography and the number of cases of OIRD. A survey of medical-surgical RNs was also conducted to gather their perceptions on the ease of use and effectiveness of capnography. Results: Twelve months after introducing the intervention, there was a statistically significant increase in monitoring frequency, with 2.56 times more patients at high risk for OIRD being monitored with capnography than at baseline (p = .006). Of the 167 RNs 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. Preliminary data suggest that the incidence of OIRD decreased after one year, although not by a statistically significant amount (p = .876). Implications for Practice: The intervention succeeded in increasing the number of high-risk patients being monitored with capnography, though the increased monitoring did not improve patient outcomes. The RN survey highlighted areas in need of further improvement, such as the supply of monitors and patient education.en_US
dc.typetexten_US
dc.typeElectronic Dissertationen_US
dc.subjectpatient safetyen_US
dc.subjectquality improvementen_US
dc.subjectrespiratory depressionen_US
dc.subjectNursingen_US
dc.subjectpain managementen_US
thesis.degree.nameD.N.P.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplineNursingen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorReel, Sally J.en_US
dc.contributor.committeememberMay, Kathleen M.en_US
dc.contributor.committeememberMichaels, Cathleen L.en_US
dc.contributor.committeememberReel, Sally J.en_US
All Items in UA Campus Repository are protected by copyright, with all rights reserved, unless otherwise indicated.