Preliminary Pre-Survey Outcomes of High-Risk Opioid,Post-Operative,Orthopedic Patient Home Monitoring: An Intermountain Research and Medical Foundation Grant Supported Study

Abstract

Background:

Patients receiving opioids are at risk of morbidity and death due to opioid-induced respiratory depression (OIRD). Time to discharge is decreasing, pushing these risks into the home setting. Monitoring systems with alarms may avert post-discharge OIRD. The feasibility of such systems for home monitoring has had limited study. It is our impression that, rather than just OSA, an inadequate minute ventilation induced by opioids and/or polypharmacy of central nervous system depressing drugs may be contributing factors to OIRD.

Methods:

The Orthopedic Specialty Hospital is the only stand-alone hospital for orthopedic care within Intermountain Healthcare. Opioids can: 1) directly inhibit respiratory musculature function from the upper airway to the diaphragm, 2) impair hypoxic/hypercapnic ventilatory response, 3) alter control of breathing at the medulla and pons, and 4) impair arousal response. With an Intermountain Research & Medical Foundation grant, we began a quantitative, prospective, non-randomized, single cohort study using Masimo RAD 97 monitoring devices to test the feasibility of 4-day, home monitoring. Pulse oximetry (SpO₂), HR, RR and capnography (ETCO₂) were recorded. Patients meeting high-risk opioid inclusion criteria and prescribed opioids were included. Patients were educated about opioid risks of OIRD and other CNS depressing medications, alarm response, Narcan administration and when to call emergency response. They were given a 24/7 number to call with questions/concerns. Upon device return, all recorded data were analyzed. Pre-study and post-study surveys were given to patients.

Results:

The study target was 500 enrolled patients or 6 months, whichever came first. As of May 13, 2020, 235 patients were enrolled in the study. Detailed pre-study patient survey results are reported in Table One.

Conclusions:

We found 4 patients never received the Naloxone or education from pharmacy; however, none had any adverse outcomes. This was a significant finding, as receiving education and Narcan is an essential component of patient safety and imperative part of the study. When Utah’s 2018 SCR004 resolution (Parker’s Bill) was signed into law, legislators requested more studies to increase awareness of opioids and to identify and monitor high risk opioid patients at home post-surgery. Preliminary study data will be reported to internal stakeholders and legislators. A manuscript will be created upon study completion. It is our impression this study will address legislative requests.

Table One: Pre-Study Patient Survey Outcomes

Table One: Pre-Study Results of Patients: September 23, 2019 through May 13, 2020	Total Ptsn=235# (%)
Pre-surveys Completed & Returned	235 (100)
Pts Who Received Education from RT About Study & Equipment	232 (99)
Pts Who Received Education from Pharmacy About Indications & How to Use Nasal Narcan	121 (52)
Pts That Received Education from Pharmacy About Mixing Other CNS Depressing Medications	122 (52)
Pts Who Watched Parker’s Video	226 (96)
Pts Who Felt More Informed About Risks of Taking Opioids After Watching Parker’s Video n=226	215 (95)
Pts Who Were Previously Unaware of the Risk of OIRD When Taking Opioids	81 (34)
Pts Who Felt They Received Adequate Education on the Importance of Home Monitoring and the Risks Associated with Taking Opioid Medications	216 (92)
Pts Who Have Taken Opioids in the Past	201 (86)
Of the 201 Pts Taking Opioids in the past, # (% ) with Previous Difficulty with Breathing	36 (15)
Of the 201 Pts Taking Opioids in the Past, # (%) Who Required Oxygen While Taking Opioids	34 (14)
Pts Who Have Gone Home on Oxygen in the Past After Surgery or Sedated Outpatient Procedure	45 (19)