Impact of Adoption of Smart Pump System With Continuous Capnography Monitoring on Opioid-Related Adverse Event Rates: Experience From a Tertiary Care Hospital

OBJECTIVES: The use of opioid analgesics for pain management in hospitalized patients is associated with a high risk of adverse events, including respiratory depression which may lead to respiratory arrest and death. Patients who experience opioid-related adverse drug reactions (ADRs) have been shown to experience longer and more costly hospital stays and have a higher risk of requiring a readmission after discharge. In this study, we report on the impact of the introduction of Wesley Medical Center's Safe Medication Practice Protocol on opioid-related ADRs. METHODS: A retrospective, pre-post cohort study using electronic health records combined with manual chart review was undertaken at the Wesley Medical Center, a 760-bed tertiary care facility. The Safe Medication Practice Protocol incorporating a smart infusion pump system with capnography monitoring was implemented in May 2010 hospital-wide. The number and severity of ADRs and the duration of opioid treatment were compared between the pre (2007-April 2010) and post (May 2010-2014) periods. RESULTS: A total of 139,734 (pre-period) versus 267,573 (post-period) patients received opioid treatment during the hospital stay. Compared with the pre-period, the post-period resulted in a 79.2% reduction in the number of severe adverse reactions (3.08 vs 0.64 per 10,000 patients treated with opioid, P < 0.0001) as well as a shorter duration of opioid treatment (average 2.05 vs 1.37 days, P < 0.0001). CONCLUSIONS: Implementing education, revisions to patient-controlled analgesia policies and procedures, and capnography monitoring with patient-controlled analgesia pause is associated with significantly lower rates of severe ADRs and shorter opioid treatment duration.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.