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that your facility is the best and safest place to care for them. On the day of sur-
gery, make certain that their physical assessment and clinical picture match
their pre-surgery screening status. Never hesitate to cancel a case if a patient is
inappropriate for the outpatient setting.
Assess all patients for the risk of oversedation and respiratory depression.
When we give opioids to patients with untreated sleep-disordered breathing,
there's an increased risk of unwanted sedation and respiratory depression. The
ability to diagnose obstructive sleep apnea (OSA) is much improved with use of
a standardized screening tool such as the STOP-BANG questionnaire. Identify
patients with undiagnosed OSA and modify their plan of care.
Always consider the risk of respiratory compromise when planning a patient's
care, and involve surgeons, anesthesiologists and nurses in creating your facili-
ty's policies and procedures on the frequency of respiratory assessments and
the types of monitors that you'll use. For example, use capnography — which
measures the amount of carbon dioxide in exhaled breath and is a true indicator
of ventilation adequacy — on all patients at risk for rising carbon dioxide levels.
Other considerations for patients with sleep apnea include minimal use of med-
ications that increase respiratory depression, such as promethazine and diphen-
hydramine. You must create a better plan for the high-risk patient.
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Monitor all physiological parameters
It's assumed that Logan was already having ventilation issues before he
was discharged. His condition was unacceptable, and required a decrease
in the opioid dose of 25 to 50%, but there was no scoring tool available at the
time to track Logan's level of sedation during the recovery period.
Monitor all patients who receive opioids with capnography for an extended
period before discharge without administration of stimulating drugs to ensure
you detect hypoxemia. Early detection of the condition allows for interventions
to correct hypoventilation, airway obstruction or apnea. You don't want these
episodes to occur once a patient returns home, where appropriate monitoring
