Patient Monitoring, Patient Safety

8 Key Steps for Ensuring Opioid Safety in Pregnant Patients: No Need to Whisper, Time to Shout Out the Need

By Lynn Razzano RN, MSN, ONCC (Clinical Nurse Consultant, Physician-Patient Alliance for Health & Safety)

Opioid management for pregnant patients requires particular care and caution. After all, there really are two lives to think about, consider and factor in – that of the mother and her baby!

With these types of concerns in mind, on Oct. 23-Oct. 24, 2014, over 200 obstetrics and gynecology nurses attended the Massachusetts chapter conference of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN).

To help identify practical tips for opioid use, I presented 8 key points of relevance for nurses in OB opioid practices and what is used as pain modalities for the OB patient:

Clinical Relevance for Perioperative Nurses

These 8 key points were first presented at the 2014 annual conference of Association of periOperative Registered Nurses (AORN).

Two of these 8 key points were particularly emphasized in comments by attendees of the AWHONN conference about opioid practices and risk factor assessment when opioids are used for pregnant patients:

  1. Assess Your Patient – A major academic teaching hospital in Boston said that they have developed a patient specific pre-opioid assessment that is stratified by High Tolerance, Moderate Tolerance, and Low Tolerance for opioids. This is the baseline risk factor assessment that is considered when ordering opioids for OB patients. It reflects their standard of risk assessment practice that has been found to decrease opioid-related adverse events and negative consequences in the pregnant woman.
  1. Monitor Your Patient – Many hospitals indicated that they conduct continuous electronic monitoring of pregnant patients receiving Duromorph (a morphine injection). The only dissenter seemed to be a moderate-size community hospital that only conducted continuous electronic monitoring of patients in the PACU. The PACU staff does not transfer the patient who just delivered back to the OB unit on continuous electronic monitoring. They identified “they do not feel the need to use continuous monitoring on the unit when the mother is receiving Duromorph.” This is a complete opposite change in practice from other hospitals queried, and these facts lend themselves to further investigation and questions.

Further illustrating the need to assess and monitor patients on opioids, a large institution related their experience after they had four “near misses”. Their response to improve patient safety was the need for more staff education, training and competency based activities as a direct result of PCA use on the labor and delivery units and the use of continuous electronic monitoring. They also implemented opioid risk factor assessment, re-assessment and being alert for subtle changes in level of sedation.

Please let us know what you have done to improve the safety of pregnant patients.

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