The Role of Surveillance Monitoring in Preventing Opioid-Related Deaths

A retrospective review of 10 years of available rescue events and patient safety data from a single-center rural tertiary care hospital was examined. We sought to evaluate the impact of surveillance monitoring (that is, continuous monitoring optimized for deterioration detection) on mortality and severe morbidity associated with administering sedative/analgesic medications in the general care setting.

The study revealed that of 111,488 patients in units with surveillance monitoring available, no patients died or were harmed by opioid-induced respiratory depression when surveillance monitoring was in use. One patient died from opioid-induced respiratory depression in a unit where surveillance monitoring was available; however, the patient was not monitored at the time of the adverse event. In unmonitored units (15,209 patients during 29 months of incremental implementation), three patients died from an opioid overdose (19.73 deaths per 100,000 at-risk patients). The reduced death rate when surveillance monitoring was available (0.0009%) versus not available (0.02%) was significant (P = 0.03).

Based on these results, it was concluded that the rescue system with continuous surveillance monitoring profoundly affected death from sedative/analgesic administration in the general care setting for the 10-year period. Thus, this approach to patient safety can help address the risk of sedative/analgesic-related respiratory arrests in hospitals.

SAC 10-year flowchart
Figure: Analysis approach. A structured approach was to identify patients who died or were harmed by postoperative administration of sedative/analgesic in general care units. Various data sources, including the electronic medical record, event databases (for example, rescues, reversals), clinical engineering equipment records, and archived physiologic data were accessed as shown during the review process.

McGrath S, McGovern K, Perreard I, Huang V, Moss L, Blike G. Inpatient Respiratory Arrest Associated with Sedative and Analgesic Medications: Impact of Continuous Monitoring on Patient Mortality and Severe Morbidity. J Patient Saf. 14 March 2020. DOI: 10.1097/PTS.0000000000000696.