At our institution, we observed an increase in opioid-related adverse events after instituting a new pain treatment protocol. To prevent this, we programmed the Omnicell drug dispensing system to page the RRT whenever naloxone was withdrawn on the general wards.
Retrospective review of a prospectively collected database with a before and after design.
When comparing the two 12-month periods, there was a decrease in monthly opioid-related cardiac arrests from 0.75 to 0.25 per month (difference = 0.5; 95% CI, 0.04–0.96, P = 0.03) and a nearly significant decrease in code deaths from 0.25 to 0 per month (difference = −0.25; 95% CI, −0.02–0.52, P = 0.07) without a significant decrease in pain satisfaction scores (difference = −2.3; 95% CI, −4.4 to 9.0, P = 0.48) over the study period. There were also decreased RRT interventions from 7.3 to 5.6 per month (difference = −1.7; 95% CI, −0.31 to −3.03, P = 0.02) and decreased inpatient transfers from 2.9 to 1.8 transfers per month (difference = −1.2; 95% CI, −0.38 to −1.96, P = 0.005). When adjusting for inpatient admissions and inpatient days, there was a decrease in opioid-related cardiac arrests from 2.9 to 0.1 per 10,000 admissions (difference = −2.0; 95% CI, −0.2 to −3.8, P = 0.03) and a decrease in cardiac arrests from 0.5 to 0.2 per 10,000 patients (difference = −0.34; 95% CI, −.02 to −0.65, P = 0.04).
Naloxone-triggered activation of the RRT resulted in reduced opioid-related inpatient cardiac arrests without adversely affecting pain satisfaction scores.