In this episode, I’ll discuss predictors of oversedation in hospitalized patients.
Opioid-induced respiratory depression (OIRD) and oversedation are significant risks to patient safety in the hospital. The ability to predict patients at risk for these consequences of opioid use could allow for monitoring to be increased and potentially less risk to patients.
Researchers at a community hospital in Billings, MT performed a retrospective analysis of hospitalized patients in an attempt to identify risk factors for opioid-induced respiratory depression (OIRD) and oversedation. 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 oversedation:
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 of 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 training modules related to opioids including: Pharmacy Pain Management Consults, PCA Dosing, Opioid Overdose Management, and Safe and Effective Opioid Use in the ICU. To get immediate access to these and other resources to help you in your practice go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.