Inadequate monitoring for respiratory depression poses the greatest
risk to patients, according to the ECRI Institute's 2016 Top 10 Patient
Safety Concerns for Healthcare Organizations (osmag.net/S3FPff).
CMS recommends you closely monitor patients receiving opioids. In
a recent guidance report (osmag.net/PurSW5), the organization
notes that each year serious adverse events, including fatalities, are
associated with the use of IV opioid medications in hospitals. These
deaths "might have been prevented with appropriate risk assessment
for adverse events as well as frequent monitoring of the patient's res-
piration rate, oxygen and sedation levels." CMS also notes that
patients receiving these drugs often are "placed in units where vital
signs and other monitoring typically is not performed as frequently as
in post-anesthesia recovery units."
Prepare and educate staff. One of the issues we learned from
the initial documents filed in the Rivers case was that the center
was not prepared for an emergency. There was said to be panic
among the providers, and one even allegedly fled once she realized
there was a serious issue. Every outpatient facility needs to have a
protocol in place for handling respiratory and other emergencies.
This doesn't simply mean having a crash cart somewhere on loca-
tion, though. Unless you have drilled for it and completely trained for
it, it can be difficult to correctly implement in an emergency. Just hav-
ing the equipment does not guarantee staff know how to use it and
use it proficiently under stress. Instead, hold regular drills and educa-
tion sessions for staff, and ensure that everyone knows what their
role is in the event of an emergency.
Dealing with scrutiny
The death of a celebrity like Joan Rivers draws extra attention and
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Medical Malpractice
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