Opioid-induced respiratory depression (OIRD) and over-sedation are significant risks to patient safety in the hospital.
But a recent study suggests these risks can be predicted.
Researchers at a community hospital in Billings, MT performed a retrospective analysis of hospitalized patients (American Journal of Health-System Pharmacy, Volume 75, Issue 18, 15 September 2018, Pages 1378–1385) in an attempt to identify risk factors for opioid-induced respiratory depression (OIRD) and over-sedation.
A total of 225 patient records were reviewed. There was a nearly even split between medical and surgical patients.
A predictive model was developed that identified 5 factors that increased the risk of over-sedation:
1. Untreated sleep apnea had an odds ratio of 32.3
2. Use of long-acting oxycodone had an odds ratio of 4.8
3. Co-morbid renal disease had an odds ratio of 4.2
4. The use of ‘prn’ hydromorphone had an odds ratio of 2.7
5. Female sex had an odds ratio of 2.4
The study was small and single-center, so these results may not have a high degree of external validity. However, they serve as an excellent starting point for areas of staff education or prospective review of opioid regimens. For example, if your site does not have an assessment process for sleep apnea, that would be a significant area for improvement. Alternatively, education on the morphine dose equivalents of hydromorphone or prospective review of patients with renal disease who are placed on opioids may be other ways to decrease risk to patients.
Members of my Hospital Pharmacy Academy have access to several in-depth practical trainings related to opioids including: Pharmacy Pain Management Consults, PCA Dosing, Opioid Overdose Management, and Safe and Effective Opioid Use in the ICU. This is in addition to many other resources to help in your practice.
Right now, you can get 7-day trial access to the Hospital Pharmacy Academy for one dollar.
Go to this page to start your trial.
-Pharmacy Joe
PS – This Hospital Pharmacy Academy trial offer will be available until 10 pm EST on Tuesday, January 28.
If you’ve been wondering if the Hospital Pharmacy Academy is the right professional resource for you, take a look at what some recent members have said:
Never did a residency? Ravi says:
I graduated this year in May and now work as an ID/Stewardship pharmacist at a small 200-bed hospital. I am trying to bridge my knowledge of what I could have possibly learned from a PGY-1 as well as PGY-2 in ID had I gone the residency route. To that effect, I decided to purchase a subscription to your Academy to fast-track myself to some of the clinical pearls and nuggets that are otherwise only learned with exposure and experience on the job or during residency that I have missed out on. The art of inpatient pharmacy is an exciting challenge for me, and I’m learning new tricks of the trade every day — your trainings offer me valuable insight. Thank you for the resources, especially for people like me who have a dire need for them owing to the lack of a formal residency training.
Want to supplement your studies for BCPS/BCCCP? Ryan, Dan & Erin say:
I’m studying for my BCCCP exam and found your Academy through a google search for supplemental material. I just wanted to say I’m highly impressed. It’s very well structured and totally relatable to practice.
I had been using the Academy to supplement my studying for the BCPS exam and to keep up to date on pharmacy materials. I recently found out I passed the exam!
I wanted to let you know that I used your Academy Masterclasses to study for the BCCCP and I just found out I passed! Thank you for this resource and keep up the good work!
Starting a new ED or critical care position? Rick says:
Currently, I am the ED pharmacist at a 600-bed community teaching hospital with a 45-bed emergency department. I was offered this position after completing a PGY-1 residency, so the learning curve has been pretty steep. However, the resources afforded to me through the Hospital Pharmacy Academy have really made the transition possible. I enjoy the fact that one monthly payment gives me access to all the content (I often venture into the ID and general hospital masterclasses for specific situations that arise in the ED).
Want to learn code blue and rapid response? Tiffany says:
I’ve been practicing hospital pharmacy for 11 years now, but always med/surgery, ortho/neuro etc and never ED or ICU. I had to attend my first ever code, two weeks ago and knew immediately I was in way over my head. I scoured the internet for some way to prepare in advance of being called to another and found your Academy. In just a weekend I did the code blue/RRT training and am especially thankful for the videos on priming the saline flush and drip bags! Thank you Pharmacy Joe for seeing a need and answering the call!
Do you lack local resources to prepare you for clinical scenarios? Janet says:
I work in a 50 bed hospital. Although I have been a pharmacist for years, I find that I have questions and need some training, but don’t have an avenue to find answers. I joined your Academy to get some confirmation and answers to clinical questions because I often feel inadequately prepared. We also precept pharmacy students and I desire to make the experience more valuable with the complementary Academy access you allow for students/residents.
Doing a PGY-2 but feel your critical care skills are sliding? Daniel says:
In particular I am just trying to get the rust off. Now that I am in my PGY2 in a different hospital, we do not handle as many critical care patients since we don’t have a level 1 trauma and I’m realizing that really I’m more drawn to critical care. I miss it a lot and I’m finding I’ve lost some of my skills and comfort level in code situations and dealing with more acute patients so I am really just trying to refresh myself on everything codes, pressors, common ICU disease states using your Masterclass trainings. I love the weekly Literature Digests by the way. I think that’s one of the hardest things trying to get into the habit of as a resident is staying up to date on literature and journals.
Doing a PGY-1 residency and want an extra edge in the job market? Mark says:
I am a PGY1 resident and am currently starting some applications for inpatient/ICU positions. I really appreciate your site because of 2 things: 1) You provide me with a new viewpoint of inpatient work 2) You provide me with additional therapy review prior to interviews. I have already had some time to work through a few ID Masterclasses and have found them helpful in helping identify gaps in knowledge. I am excited to continue exploring your Academy and gathering additional information you have to offer.
Want to keep your skills current in a competitive job market? Karen says:
I practice in an academic medical center where my job is focused on purely the operational dispensing functions of the pharmacy. My department is big enough that clinical and operational functions can be quite silo’d from each other and the staff tend to be quite specialized in their roles. I have been doing operations for years and it is what I enjoy. Recently, due to advances in automation my role is going to evolve and that is why I have signed up for your Academy.
Want to pass ACLS? Ryan says:
I passed my ACLS thanks to your Academy code blue training program! I can’t thank you enough.
Want to be able to get a response from Pharmacy Joe when you have a clinical question? Sally says:
I love your site. I listen to the Masterclasses on my way home from work and whenever I have free time. The Members-only forum is great for specific questions to see if anyone else has input and I appreciate all of your input. I have used the site to research multiple questions that I had. All in all, it’s been a great resource for me. It’s like ‘phoning a friend’ and saying ‘hey what do you think about this’!!! Thanks again for everything you do!
Want practical training that you can use in real life situations? Emily says:
I am now currently an inpatient clinical pharmacist working in a small rural hospital. We only have ~30 miles of paved road in the entire town – most are either dirt or ice! We serve as a hub for around 50+ (more) rural villages, and anyone who is sick, or critically ill often comes to us (usually via plane, but sometimes snowmobile!) to be stabilized and then sent out via Life Flight or a Med Evac. While we are not given the title, we are often called upon to act in the role of an emergency medicine/critical care pharmacist. Much of what you describe in your Academy code blue training program about what to see/expect/do in code blue/rapid response situations I have just begun seeing in real situations, and its all really good advice!
Want to enhance your clinical pharmacy skills? Lanny says:
I completed my residency at a larger teaching hospital. Presently, I basically split my time on a general medicine floor and the ICU about two weeks each per month. Although I did get ICU training in residency, I mostly did general medicine for the last three years and only started in the ICU about six months ago. I joined your Academy for a refresher on standard ICU pharmacist topics and how a more seasoned ICU pharmacist works so I can adapt my process. I’m also enjoying learning about new topics in the literature/evidence from the Academy weekly literature digests – I used to feel that I was missing out on the things other pharmacists/experts were talking about in terms of new topics and studies. Enjoying the material very much!