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Implementing a Clinical Practice Guideline on Opioid-Induced Advancing Sedation and Respiratory Depression

Kamendat, Josephine DNP, RN; Dabney, Beverly W. PhD, RN; McFarland, Marilyn PhD, RN, FNP-BC, CTN-A; Gilbert, Gregory E. EdD, MSPH, PStat®; Richards-Weatherby, Kathleen MSA, RN, BSN

doi: 10.1097/NCQ.0000000000000406
Original Article: PDF Only

Background: Opioid-induced respiratory depression (OIRD) is a serious adverse reaction associated with opioid administration.

Local Problem: The purpose of this quality improvement study was to evaluate the impact of implementing a clinical practice guideline for OIRD in a medical-surgical setting lacking standardized monitoring techniques and reporting criteria for patients receiving opioid analgesia.

Methods: An American Society for Pain Management Nursing protocol was implemented in 4 medical/surgical units. The impact on OIRD-related nurse knowledge, documentation, and opioid-related rapid response calls was measured pre- and postimplementation.

Results: Nurse OIRD-related knowledge significantly increased. The number of naloxone administrations associated with prior intravenous opioid analgesic administration did not significantly change. However, there was a significant decrease in the postimplementation number of respiratory distress–related rapid response calls.

Conclusions: Implementation of the American Society for Pain Management Nursing guidelines had a positive impact on knowledge, documentation, early intervention of OIRD, and the number of opioid-related rapid response calls.

Wound Care/Family Practice, McLaren Port Huron/Lighthouse Family Medicine, Port Huron, Michigan (Dr Kamendat); University of Michigan-Flint School of Nursing, Flint, Michigan (Drs Dabney and McFarland); ∑igma∑tats® Consulting, LLC, Charleston, South Carolina (Dr Gilbert); and Education, Outpatient Services, and Informatics, McLaren Port Huron, Port Huron, Michigan (Ms Richards-Weatherby).

Correspondence: Beverly W. Dabney, PhD, RN, University of Michigan-Flint School of Nursing, 303 E Kearsley St, Flint, MI 48502 (

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: March 11, 2019

Published ahead of print: May 14, 2019

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