This month, the Joint Commission (an independent, not-for-profit organization that accredits and certifies more than 19,000 health care organizations and programs in the United States) has issued a “Sentinel Event Alert” regarding the safe use of opioids that are prescribed and administered within the inpatient hospital setting. In its alert, the Joint Commission urges hospitals to take specific steps to prevent serious complications or even deaths from opioid use.
Some common opioids are hydrocodone, oxycodone, hydromorphone, morphine, the fentanyl or Duragesic patch, and methadone. Opioid painkillers rank among the drugs most frequently associated with adverse drug events, including respiratory depression. Some of the causes for adverse events associated with opioid use are:
- Lack of knowledge about potency differences among opioids.
- Improper prescribing and administration of multiple opioids and modalities of opioid administration (i.e., oral, parenteral and transdermal patches).
- Inadequate monitoring of patients on opioids.
Of the opioid-related adverse drug events (including deaths), 47 percent were wrong dose medication errors, 29 percent were related to improper monitoring of the patient, and 11 percent were related to other factors, including excessive dosing, medication interactions and adverse drug reactions.*
According to the Joint Commision’s Sentinel Alert, when opioids are administered, the potential for opioid-induced respiratory depression should always be considered because:
- The risk may be greater with higher opioid doses
- The occurrence may actually be higher than reported
- There is a higher incidence observed in clinical trials
- Various patients are at higher risk (see below), including patients with sleep apnea, patients who are morbidly obese, who are very young, who are elderly, who are very ill, and who concurrently receive other drugs that are central nervous system and respiratory depressants (e.g., anxiolytics, sedatives).
The Alert explains that organizations should make staff aware of the following factors and activities that can help avoid accidental opioid overuse:
- Screen patients for respiratory depression risk factors
- Assess the patient’s previous history of analgesic use or abuse, duration and possible side effects to identify potential opioid tolerance or intolerance.
- Conduct a full body skin assessment of patients prior to administering a new opioid to rule out the possibility that the patient has an applied fentanyl patch or implanted drug delivery system or infusion pump.
- Use an individualized, multimodal treatment plan to manage pain.
- Take extra precautions with patients who are new to opioids or who are being restarted on opioids.
- Consult a pharmacist or pain management expert (when available) when converting from one opioid to another, or changing the route of administration (from oral to IV or transdermal).
- Avoid rapid dose escalation of opioid analgesia above routine dose levels in opioid- tolerant patients.
- Take extra precautions when transferring patients between care units and facilities, and
- Avoid using opioids to meet an arbitrary pain rating or a planned discharge date. Dosing should be based on the individual patient’s need and condition.
As the Joint Commission’s recent alert makes plain, prescription opioid painkillers are dangerous. If a loved one has died while using any of the many available, powerful opioid painkillers, do not assume the drug was properly prescribed, administered and monitored. Our many years of lawsuits regarding these powerful drugs have taught us that doctors and hospitals are often uneducated and inexperienced when it comes to prescribing, administering and monitoring patient’ with regard to these drugs.
If a loved one has died and you feel prescription opioid painkillers may have been the cause, the lawyers at Heygood, Orr & Pearson have handled numerous opioid-related death lawsuits and are available for a free legal consultation about your case. To find out if you are eligible, call us toll-free at 1-877-446-9001, or fill out our free online case evaluation form, and one of our representatives will contact you for more information.