Introduction

Changes in patient populations, along with economic and practical considerations, have led to an overall increase in patient acuity on the general care floor (GCF). Despite the presence of higher risk patients, current GCF surveillance is often limited to isolated spot checks of core vital signs, such as heart rate, respiratory rate, blood pressure and temperature, with such observations often limited to every 4 hours, which leaves patients unmonitored 96% of the time.([FOOTNOTE=Weinger, M. B., & Lee, L. A. No Patient Shall Be Harmed By Opioid-Induced Respiratory Depression. APSF Newsletter. 2011;26(2):21.],[ANCHOR=],[LINK=]) Therefore, these patients may be placed at increased risk for respiratory compromise.

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Respiratory Compromise Among Patients on the General Care Floor

Respiratory Compromise Among Patients on the General Care Floor
26.8% Percentage of acute respiratory compromise events that occure on the GFC([FOOTNOTE=Wang, H. E., Abella, B. S., & Callaway, C. W. Risk of cardiopulmonary arrest after acute respiratory compromise in hospitalized patients. Resuscitation. 2008;79(2):234-240.],[ANCHOR=],[LINK=])
41% Percentage of patients on the GCF receiveing opioids who suffer bradynea([FOOTNOTE=Overdyk, F. J., Carter, R., Maddox, R. R., Callura, J., Herrin, A. E., & Henriquez, C. Continuous oximetry/capnometry monitoring reveals frequent desaturation and bradypnea during patient-controlled analgesia. Anesth Analg. 2007;105(2):412-418.],[ANCHOR=],[LINK=])
50% Percentage of patients with respiratory compromise on the GCF for whom intervention was delayed by greater than 30 minutes([FOOTNOTE=Quach, J. L., Downey, A. W., Haase, M., Haase-Fielitz, A., Jones, D., & Bellomo, R. Characteristics and outcomes of patients receiving a medical emergency team review for respiratory distress or hypotension. J Crit Care. 2008;23(3):325-331.],[ANCHOR=],[LINK=])
12 hours Median time of delayed intervention for patients suffering respiratory compromise on the GCF4
2.10 Odds ration for mortality in patients with delayed intervention on the GCF following respiratory compromise4

The Anesthesia Patient Safety Foundation (APSF), American Society for Pain Management (ASPMN), American Society of Anesthesiologists (ASA), and the Joint Commission currently recommend patient monitoring system of both oxygenation and ventilation with pulse oximetry and capnography in postoperative patients at-risk for respiratory compromise.([FOOTNOTE=Anesthesia Patient Safety Foundation. Essential Monitoring Strategies to Detect Clinically Significant Drug-Induced Respiratory Depression in the Postoperative Period. Conclusions and Recommendations. https://www.apsf.org/announcements.php?id=7. 2011.],[ANCHOR=],[LINK=]),([FOOTNOTE=ASA Standards for Basic Anesthetic Monitoring, Committee of Origin: Standards and Practice Parameters (Approved by the ASA House of Delegates on October 21, 1986, and last amended on October 20, 2010 with an effective date of July 1, 2011) - Viewed 3-21-11 at http://www.asahq.org/sitecore%20modules/web/~/media/modules/digital%20briefcase%20apps/asa%20practice%20management/standards%20guidelines%20statements/anesthesia%20care/standards-for-basic-anesthetic-monitoring.pdf.],[ANCHOR=View Abstract],[LINK=http://www.asahq.org/sitecore%20modules/web/~/media/modules/digital%20briefcase%20apps/asa%20practice%20management/standards%20guidelines%20statements/anesthesia%20care/standards-for-basic-anesthetic-monitoring.pdf ]),([FOOTNOTE=Jarzyna, D., Jungquist, C. R., Pasero, C., et al. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Manag Nurs. 2011;12(3):118-145 e110.],[ANCHOR=],[LINK=]),([FOOTNOTE=The Joint Commission. Safe use of opioids in hospitals. Sentinel Event Alert. 2012;849(8):1-5.],[ANCHOR=],[LINK=]) Recommendations from the APSF specifically state that continuous electronic monitoring of oxygenation and ventilation should be available and considered for all patients and would reduce the likelihood of unrecognized clinically significant opioid-induced depression of ventilation in the postoperative period.5

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