The Urgent Need in Hospitals

The data on respiratory depression in the hospital is alarming – increased use of patient-controlled analgesia (PCA) and increasing numbers of patients presenting with obesity and diagnosed or undiagnosed sleep apnea have significantly increased the risk of adverse or fatal events1:

  • Patients receiving opioids are at risk for drug-induced respiratory depression. If not detected, this condition can quickly lead to anoxic brain injury or death.
  • According to the Association for the Advancement of Medical Instrumentation (AAMI) Foundation, 50% of medication deaths are attributable to opioids, and each year more than 20,000 patients administered opioids experience respiratory depression arrests – costing the U.S. healthcare system $2 billion each year.
  • One of the most common monitoring methods – periodic physical spot checks by direct-care clinical staff – can leave patients unmonitored up to 96% of the time.
  • According to The Joint Commission’s Sentinel Event database, 29% of adverse events are related to improper patient monitoring.

The ECRI Institute named undetected opioid-induced respiratory depression as one of the top 10 Health Technology Hazards for 20172. In addition, both The Joint Commission3 and AAMI Foundation4 recommend continuous respiratory monitoring of patients receiving sedatives to prevent adverse events.

Challenges and Limitations

Until now, most efforts to mitigate the risk of respiratory depression have had limited success, due to a number of inherent challenges:

  • Patients needing surveillance are often in General Care or Medical-Surgical departments that have a higher nurse-to-patient ratio and lack systems that provide for continuous measurement and surveillance of patients
  • Many hospitals have moved to single-patient rooms, reducing the visual and audible oversight capability of clinicians
  • Most devices, (pulse oximeters and capnographs), are susceptible to a variety of artifacts that produce a high number of false and non-clinically actionable alarms, increasing the risk of alarm fatigue
  • Devices typically lack the ability to send alarms and real-time patient data to mobile clinical communication tools (VoIP phones or Smartphone applications)

Respiratory Depression Safety Surveillance

Building on our leadership in vendor-neutral medical device connectivity and real-time patient safety applications, Capsule’s Respiratory Depression Safety Surveillance (RDSS) application is a revolutionary solution. In a published, peer-reviewed clinical study5 of patients diagnosed or suspected to have Obstructive or Central Sleep Apnea, the use of Capsule’s (formerly Bernoulli Health’s) RDSS analytics with multi-variable thresholds reduced 22,812 alarms generated by bedside capnographs and pulse oximeters to just 209 respiratory depression alerts delivered to clinicians’ mobile phones, a reduction of over 90%. More importantly, the RDSS analytics alerted for every patient that experienced an actual respiratory depression episode – all patients at risk were identified early enough by the analytic to be aroused and avoid the need for any rapid response team deployment, intubation or escalation in care.

Many alarm management systems from other vendors utilize criteria that requires alarms from devices to be sustained for a certain period of time before sending an alert to a mobile clinician. In this same study, use of a 30-second sustained alarm criteria still resulted in over 13,000 alarms, potentially putting both patients and clinicians at risk due to alarm fatigue.

Another study has shown that early detection and clinical intervention for patients at risk of respiratory depression can result in savings of over $1 million dollars a year, through the avoidance of transfers to ICU, reduced length of stay and improved patient flow.6

Read the award-winning study: “Continuous Surveillance of Sleep Apnea Patients in a Medical-Surgical Unit”, published in the peer-reviewed Journal of Biomedical Instrumentation & Technology (BI&T).

Click here to access the article.

Pain Management in Hospitals — What Patients and Families Need To Know

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1
HealthGrades “Patient Safety in American Hospitals” Study, March 2011.
2
Top 10 Health Technology Hazards for 2017, Health Devices, ECRI Institute, Nov. 2016.
3
The Joint Commission, Sentinel Event Alert, Issue 49, Aug. 8, 12
4
Opioid Safety & Patient Monitoring Conference Compendium, AAMI Foundation, Nov. 2014.
5
Continuous Surveillance of Sleep Apnea Patients in a Medical-Surgical Unit, BI&T, May/June 2017.
6
Opioid Safety & Patient Monitoring Conference Compendium, AAMI Foundation Nov. 2014.