Publications by authors named "Carla R Jungquist"

43 Publications

Patient Deterioration on General Care Units: A Concept Analysis.

ANS Adv Nurs Sci 2022 Apr-Jun 01;45(2):E56-E68. Epub 2021 Dec 7.

School of Nursing, University at Buffalo (SUNY Buffalo), Buffalo, New York.

Patient deterioration is a phenomenon that occurs from the inability to recognize it or respond to a change in condition. Despite the published reports on recognizing a deteriorating patient on general care floors, a gap remains in the ability of nurses to describe the concept, affecting patient outcomes. Walker and Avant's approach was applied to analyze patient deterioration. The aim of this article was to explore and clarify the meaning of patient deterioration and identify attributes, antecedents, and consequences. The defining attributes were compared to early warning scores. An operational definition was developed and its value to nurses established.
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http://dx.doi.org/10.1097/ANS.0000000000000396DOI Listing
May 2022

Predicting Prolonged Apnea During Nurse-Administered Procedural Sedation: Machine Learning Study.

JMIR Perioper Med 2021 Oct 5;4(2):e29200. Epub 2021 Oct 5.

Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada.

Background: Capnography is commonly used for nurse-administered procedural sedation. Distinguishing between capnography waveform abnormalities that signal the need for clinical intervention for an event and those that do not indicate the need for intervention is essential for the successful implementation of this technology into practice. It is possible that capnography alarm management may be improved by using machine learning to create a "smart alarm" that can alert clinicians to apneic events that are predicted to be prolonged.

Objective: To determine the accuracy of machine learning models for predicting at the 15-second time point if apnea will be prolonged (ie, apnea that persists for >30 seconds).

Methods: A secondary analysis of an observational study was conducted. We selected several candidate models to evaluate, including a random forest model, generalized linear model (logistic regression), least absolute shrinkage and selection operator regression, ridge regression, and the XGBoost model. Out-of-sample accuracy of the models was calculated using 10-fold cross-validation. The net benefit decision analytic measure was used to assist with deciding whether using the models in practice would lead to better outcomes on average than using the current default capnography alarm management strategies. The default strategies are the aggressive approach, in which an alarm is triggered after brief periods of apnea (typically 15 seconds) and the conservative approach, in which an alarm is triggered for only prolonged periods of apnea (typically >30 seconds).

Results: A total of 384 apneic events longer than 15 seconds were observed in 61 of the 102 patients (59.8%) who participated in the observational study. Nearly half of the apneic events (180/384, 46.9%) were prolonged. The random forest model performed the best in terms of discrimination (area under the receiver operating characteristic curve 0.66) and calibration. The net benefit associated with the random forest model exceeded that associated with the aggressive strategy but was lower than that associated with the conservative strategy.

Conclusions: Decision curve analysis indicated that using a random forest model would lead to a better outcome for capnography alarm management than using an aggressive strategy in which alarms are triggered after 15 seconds of apnea. The model would not be superior to the conservative strategy in which alarms are only triggered after 30 seconds.
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http://dx.doi.org/10.2196/29200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527383PMC
October 2021

Modeling the Cost Savings of Continuous Pulse Oximetry and Capnography Monitoring of United States General Care Floor Patients Receiving Opioids Based on the PRODIGY Trial.

Adv Ther 2021 07 24;38(7):3745-3759. Epub 2021 May 24.

Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.

Introduction: Despite the high incidence of respiratory depression on the general care floor and evidence that continuous monitoring improves patient outcomes, the cost-benefit of continuous pulse oximetry and capnography monitoring of general care floor patients remains unknown. This study modeled the cost and length of stay savings, investment break-even point, and likelihood of cost savings for continuous pulse oximetry and capnography monitoring of general care floor patients at risk for respiratory depression.

Methods: A decision tree model was created to compare intermittent pulse oximetry versus continuous pulse oximetry and capnography monitoring. The model utilized costs and outcomes from the PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial, and was applied to a modeled cohort of 2447 patients receiving opioids per median-sized United States general care floor annually.

Results: Continuous pulse oximetry and capnography monitoring of high-risk patients is projected to reduce annual hospital cost by $535,531 and cumulative patient length of stay by 103 days. A 1.5% reduction in respiratory depression would achieve a break-even investment point and justify the investment cost. The probability of cost saving is ≥ 80% if respiratory depression is decreased by ≥ 17%. Expansion of continuous monitoring to high- and intermediate-risk patients, or to all patients, is projected to reach a break-even point when respiratory depression is reduced by 2.5% and 3.5%, respectively, with a ≥ 80% probability of cost savings when respiratory depression decreases by ≥ 27% and ≥ 31%, respectively.

Conclusion: Compared to intermittent pulse oximetry, continuous pulse oximetry and capnography monitoring of general care floor patients receiving opioids has a high chance of being cost-effective.

Trial Registration: www.clinicaltrials.gov , Registration ID: NCT02811302.
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http://dx.doi.org/10.1007/s12325-021-01779-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143066PMC
July 2021

Opioid-induced respiratory depression increases hospital costs and length of stay in patients recovering on the general care floor.

BMC Anesthesiol 2021 03 20;21(1):88. Epub 2021 Mar 20.

University Medical Center, Utrecht, Netherlands.

Background: Opioid-induced respiratory depression is common on the general care floor. However, the clinical and economic burden of respiratory depression is not well-described. The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial created a prediction tool to identify patients at risk of respiratory depression. The purpose of this retrospective sub-analysis was to examine healthcare utilization and hospital cost associated with respiratory depression.

Methods: One thousand three hundred thirty-five patients (N = 769 United States patients) enrolled in the PRODIGY trial received parenteral opioids and underwent continuous capnography and pulse oximetry monitoring. Cost data was retrospectively collected for 420 United States patients. Differences in healthcare utilization and costs between patients with and without ≥1 respiratory depression episode were determined. The impact of respiratory depression on hospital cost per patient was evaluated using a propensity weighted generalized linear model.

Results: Patients with ≥1 respiratory depression episode had a longer length of stay (6.4 ± 7.8 days vs 5.0 ± 4.3 days, p = 0.009) and higher hospital cost ($21,892 ± $11,540 vs $18,206 ± $10,864, p = 0.002) compared to patients without respiratory depression. Patients at high risk for respiratory depression, determined using the PRODIGY risk prediction tool, who had ≥1 respiratory depression episode had higher hospital costs compared to high risk patients without respiratory depression ($21,948 ± $9128 vs $18,474 ± $9767, p = 0.0495). Propensity weighted analysis identified 17% higher costs for patients with ≥1 respiratory depression episode (p = 0.007). Length of stay significantly increased total cost, with cost increasing exponentially for patients with ≥1 respiratory depression episode as length of stay increased.

Conclusions: Respiratory depression on the general care floor is associated with a significantly longer length of stay and increased hospital costs. Early identification of patients at risk for respiratory depression, along with early proactive intervention, may reduce the incidence of respiratory depression and its associated clinical and economic burden.

Trial Registration: ClinicalTrials.gov , NCT02811302 .
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http://dx.doi.org/10.1186/s12871-021-01307-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980593PMC
March 2021

Healthcare Shift Workers' Temporal Habits for Eating, Sleeping, and Light Exposure: A Multi-Instrument Pilot Study.

J Circadian Rhythms 2020 Oct 21;18. Epub 2020 Oct 21.

School of Nursing, University at Buffalo, Buffalo, NY, US.

Background: Circadian misalignment can impair healthcare shift workers' physical and mental health, resulting in sleep deprivation, obesity, and chronic disease. This multidisciplinary research team assessed eating patterns and sleep/physical activity of healthcare workers on three different shifts (day, night, and rotating-shift). To date, no study of real-world shift workers' daily eating and sleep has utilized a largely-objective measurement.

Method: During this fourteen-day observational study, participants wore two devices (Actiwatch and Bite Technologies counter) to measure physical activity, sleep, light exposure, and eating time. Participants also reported food intake via food diaries on personal mobile devices.

Results: In fourteen (5 day-, 5 night-, and 4 rotating-shift) participants, no baseline difference in BMI was observed. Overall, rotating-shift workers consumed fewer calories and had less activity and sleep than day- and night-shift workers. For eating patterns, compared to night- and rotating-shift, day-shift workers ate more frequently during work days. Night workers, however, consumed more calories at work relative to day and rotating workers. For physical activity and sleep, night-shift workers had the highest activity and least sleep on work days.

Conclusion: This pilot study utilized primarily objective measurement to examine shift workers' habits outside the laboratory. Although no association between BMI and eating patterns/activity/sleep was observed across groups, a small, homogeneous sample may have influenced this. Overall, shift work was associated with 1) increased calorie intake and higher-fat and -carbohydrate diets and 2) sleep deprivation. A larger, more diverse sample can participate in future studies that objectively measure shift workers' real-world habits.
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http://dx.doi.org/10.5334/jcr.199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583716PMC
October 2020

Prediction of Opioid-Induced Respiratory Depression on Inpatient Wards Using Continuous Capnography and Oximetry: An International Prospective, Observational Trial.

Anesth Analg 2020 10;131(4):1012-1024

Trident Anesthesia Group, LLC, Charleston, South Carolina.

Background: Opioid-related adverse events are a serious problem in hospitalized patients. Little is known about patients who are likely to experience opioid-induced respiratory depression events on the general care floor and may benefit from improved monitoring and early intervention. The trial objective was to derive and validate a risk prediction tool for respiratory depression in patients receiving opioids, as detected by continuous pulse oximetry and capnography monitoring.

Methods: PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) was a prospective, observational trial of blinded continuous capnography and oximetry conducted at 16 sites in the United States, Europe, and Asia. Vital signs were intermittently monitored per standard of care. A total of 1335 patients receiving parenteral opioids and continuously monitored on the general care floor were included in the analysis. A respiratory depression episode was defined as respiratory rate ≤5 breaths/min (bpm), oxygen saturation ≤85%, or end-tidal carbon dioxide ≤15 or ≥60 mm Hg for ≥3 minutes; apnea episode lasting >30 seconds; or any respiratory opioid-related adverse event. A risk prediction tool was derived using a multivariable logistic regression model of 46 a priori defined risk factors with stepwise selection and was internally validated by bootstrapping.

Results: One or more respiratory depression episodes were detected in 614 (46%) of 1335 general care floor patients (43% male; mean age, 58 ± 14 years) continuously monitored for a median of 24 hours (interquartile range [IQR], 17-26). A multivariable respiratory depression prediction model with area under the curve of 0.740 was developed using 5 independent variables: age ≥60 (in decades), sex, opioid naivety, sleep disorders, and chronic heart failure. The PRODIGY risk prediction tool showed significant separation between patients with and without respiratory depression (P < .001) and an odds ratio of 6.07 (95% confidence interval [CI], 4.44-8.30; P < .001) between the high- and low-risk groups. Compared to patients without respiratory depression episodes, mean hospital length of stay was 3 days longer in patients with ≥1 respiratory depression episode (10.5 ± 10.8 vs 7.7 ± 7.8 days; P < .0001) identified using continuous oximetry and capnography monitoring.

Conclusions: A PRODIGY risk prediction model, derived from continuous oximetry and capnography, accurately predicts respiratory depression episodes in patients receiving opioids on the general care floor. Implementation of the PRODIGY score to determine the need for continuous monitoring may be a first step to reduce the incidence and consequences of respiratory compromise in patients receiving opioids on the general care floor.
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http://dx.doi.org/10.1213/ANE.0000000000004788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467153PMC
October 2020

Prediction model development of women's daily asthma control using fitness tracker sleep disruption.

Heart Lung 2020 Sep - Oct;49(5):548-555. Epub 2020 Feb 20.

Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.

Background: Night-time wakening with asthma symptoms is an important indicator of disease control and severity, with no gold-standard objective measurement.

Objective: The study objective was to use fitness tracker sleep data to develop predictive models of daily disease control-related asthma-specific wakening and FEV in working-aged women with poorly controlled asthma.

Methods: A repeated measures panel design included data from 43 women with poorly controlled asthma. Two components of asthma control were the primary outcomes, measured daily as (1) self-reported asthma-specific wakening and (2) self-administered spirometry to measure FEV. Data were analyzed using generalized linear mixed models.

Results: Our models demonstrated predictive value (AUC=0.77) for asthma-specific night-time wakening and good predictive value (AUC=0.83) for daily FEV CONCLUSIONS: Fitness tracker sleep efficiency and wake counts demonstrate clinical utility as predictive of asthma-specific night-time wakening and daily FEV Fitness tracker sleep data demonstrated predictive capability for daily asthma outcomes.
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http://dx.doi.org/10.1016/j.hrtlng.2020.01.013DOI Listing
March 2021

Nurse-Delivered Brief Behavioral Treatment for Insomnia in Lung Cancer Survivors: A Pilot RCT.

Behav Sleep Med 2020 Nov-Dec;18(6):774-786. Epub 2019 Oct 31.

School of Nursing, University at Buffalo, State University of New York , Buffalo, New York.

: Insomnia occurs in 50 to 80% of lung cancer survivors. Cognitive behavioral therapy is the standard treatment for insomnia (CBTI); however, treatment length and lack of psychologists trained in CBTI limits access. Brief Behavioral Treatment for Insomnia (BBTI), a nurse-delivered modified CBTI, is proposed. This feasibility pilot study sought to compare the BBTI intervention to attention control Healthy Eating Program (HEP) for insomnia in lung cancer survivors. : The participants comprised adults, 21 years of age or older with insomnia and stage I/II non-small cell lung cancer, more than 6 weeks from surgery and living in Western NY. : Participants (n = 40) were randomly assigned to an experimental (BBTI) or attention control condition (Healthy Eating Program). Thirty participants completed the study. : Participants were 66 years of age (± 7.6; range 53-82), 40% (n = 16) male, 87.5% (n = 35) Caucasian, 50% (n = 20) married, BMI 27.7 (± 5.8), and 12% (n = 5) never smokers. Baseline sleep diary sleep efficiency, ISI and other baseline covariates were balanced between the groups. Sleep efficiency improved ≥85% in BBTI group ( = .02), but not in HEP control group ( = 1.00). Mean ISI for BBTI and attention control were 6.40 ± 4.98 and 14.10 ± 4.48 ( = .001) respectively. In addition, BBTI group mean total FACT-L score improved by 6.66 points from baseline while HEP group score worsened ( = .049). : BBTI is a practical, evidence-based, clinically relevant intervention that improved sleep and quality of life in lung cancer survivors with insomnia. Additional research to evaluate efficacy, duration, and implementation strategies are essential.
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http://dx.doi.org/10.1080/15402002.2019.1685523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190424PMC
February 2021

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions.

Pain Manag Nurs 2020 02 31;21(1):7-25. Epub 2019 Jul 31.

University of Pennsylvania, Philadelphia, Pennsylvania.

Objectives: This report presents up-to-date evidence and expert consensus-based revisions to the ASPMN 2011 guidelines that inform interprofessional clinical decision-making for hospitalized adults receiving opioid analgesics.

Design: Systematic review of the literature.

Methods: A 14-member expert panel was charged with reviewing and grading the strength of scientific evidence published in peer reviewed journals and revising the ASPMN 2011 existing guidelines. Panel members formulated recommendations based on the strength of evidence and reached consensus through discussion, reappraisal of evidence, and voting by majority when necessary. The American Society of Anesthesiologists evidence categories for grading and classifying the strength of the evidence were used. Recommendations were subjected to a critical review by ASPMN members as well as external reviews.

Results: The 2011 guidelines were found to still be relevant to clinical practice, but new evidence substantiated refinement and more specific recommendations for electronic monitoring. The revised guidelines present risk factors divided into three categories: patient-specific, treatment-related, and environment of care. Specific recommendations for the use of electronic monitoring are delineated.

Conclusions: All hospitalized patients that are administered opioids for acute pain are at risk of opioid induced advancing sedation and respiratory depression, but some patients are at high risk and require extra vigilance to prevent adverse events. All patients must be assessed for level of risk. Adaptations to the plan of care and monitoring strategies should be driven by iterative re-assessments according to level of risk.

Nursing Practice Implications: Opioid medications continue to be a major component in the management of acute pain. Clinicians have the primary responsibility for safe and effective pain management. Evidence based monitoring strategies can improve patient safety with opioids.
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http://dx.doi.org/10.1016/j.pmn.2019.06.007DOI Listing
February 2020

Opioid-Induced Sedation and Respiratory Depression: Are Sedation Scales Enough to Prevent Adverse Drug Events Postoperatively?

Pain Manag Nurs 2020 02 15;21(1):110-119. Epub 2019 May 15.

School of Nursing, University at Buffalo (SUNY Buffalo), Buffalo, New York.

Objectives: Nurses who care for hospitalized patients are responsible for ensuring adequate pain management is provided in a safe manner. The clinical challenge is balancing the effective control of the patient's pain with the side effects of administering opioids. The aim of this literature review is to explore the evidence on how nurses assess for opioid-induced sedation and advancing respiratory depression and how they integrate those data in their critical thinking skills when deciding to administer opioids for pain.

Design: A matrix method was used to guide the review and synthesis of the evidence. Tables with column headings (citation, purpose of study, design/measurements, outcomes, and results) were constructed to record data extracted from each study.

Data Sources: Primary source research articles were examined using the MESH terms sedation, sedation scale, respiratory depression, opioid, pain, pain assessment, adverse events, naloxone and postoperative.

Review/analysis Methods: Original studies such as retrospective case-control studies and descriptive studies were included. The final studies that met the inclusion criteria and were independently reviewed by the authors. The two main areas of interest were the evidence for how nurses assess for advancing sedation and excessive respiratory depression and how nurses integrate their assessment data in their critical thinking skills when deciding to administer opioids for pain.

Results: Results indicated a lack of evidence examining the relationships among sedation, respiratory depression, and adverse events and the overall impact of managing these variables on patients' pain.

Conclusions: This review revealed a lack of evidence between how nurses assess for opioid induced advancing sedation and excessive respiratory depression, and the impact, including the adverse events associate with acute pain management.
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http://dx.doi.org/10.1016/j.pmn.2018.09.009DOI Listing
February 2020

Identifying Patients Experiencing Opioid-Induced Respiratory Depression During Recovery From Anesthesia: The Application of Electronic Monitoring Devices.

Worldviews Evid Based Nurs 2019 Jun 2;16(3):186-194. Epub 2019 May 2.

Department of Computer Science and Engineering, University at Buffalo, Buffalo, NY, USA.

Background: Postsurgical patients experiencing opioid-related adverse drug events have 55% longer hospital stays, 47% higher costs associated with their care, 36% increased risk of 30-day readmission, and 3.4 times higher risk of inpatient mortality compared to those with no opioid-related adverse drug events. Most of the adverse events are preventable.

General Aim: This study explored three types of electronic monitoring devices (pulse oximetry, capnography, and minute ventilation [MV]) to determine which were more effective at identifying the patient experiencing respiratory compromise and, further, to determine whether algorithms could be developed from the electronic monitoring data to aid in earlier detection of respiratory depression.

Materials And Methods: A study was performed in the postanesthesia care unit (PACU) in an inner city. Sixty patients were recruited in the preoperative admissions department on the day of their surgery. Forty-eight of the 60 patients wore three types of electronic monitoring devices while they were recovering from back, neck, hip, or knee surgery. Machine learning models were used for the analysis.

Results: Twenty-four of the 48 patients exhibited sustained signs of opioid-induced respiratory depression (OIRD). Although the SpO values did not change, end-tidal CO levels increased, and MV decreased, representing hypoventilation. A machine learning model was able to predict an OIRD event 10 min before the actual event occurred with 80% accuracy.

Linking Evidence To Action: Electronic monitoring devices are currently used as a tool to assess respiratory status using thresholds to distinguish when respiratory depression has occurred. This study introduces a potential paradigm shift from a reactive approach to a proactive approach that would identify a patient at high risk for OIRD. Capnography and MV were found to be effective tools in detecting respiratory compromise in the PACU.
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http://dx.doi.org/10.1111/wvn.12362DOI Listing
June 2019

Preventing Opioid-Induced Respiratory Depression in the Hospitalized Patient With Obstructive Sleep Apnea.

J Perianesth Nurs 2018 Oct 15;33(5):601-607. Epub 2017 Sep 15.

Purpose: To enhance the role of nursing interventions in the management of perioperative opioid-induced respiratory depression (OIRD) in patients with obstructive sleep apnea (OSA).

Design: Narrative review of the literature.

Methods: Literature reviewed with emphasis on recommendations by professional and accrediting organizations.

Findings: Postsurgical OIRD increases hospital stay (55%), cost of care (47%), 30-day readmission (36%), and inpatient mortality (3.4 fold). OSA increases the risk of OIRD and may result in legal claims averaging $2.5 million per legal claim.

Conclusions: Nursing interventions are essential to improving outcome and reduce cost in the management of postsurgical OIRD in OSA patients.
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http://dx.doi.org/10.1016/j.jopan.2016.09.013DOI Listing
October 2018

The common meanings and shared practices of sedation assessment in the context of managing patients with an opioid: A phenomenological study.

J Clin Nurs 2019 Jan 27;28(1-2):104-115. Epub 2018 Sep 27.

School of Nursing, University at Buffalo (SUNY Buffalo), Buffalo, New York.

Aims And Objectives: To examine the common meanings of opioid-induced sedation and shared practices in the context of post-operative pain management in expert Post-Anesthesia Care Unit nurses during patient's pain management with opioids.

Background: Within the clinical setting, linear pain and sedation scales are not enough to support clinical judgement with acute pain management. Because sedation measurement rests along a fluctuating continuum, it is possible for a patient to be sedated and then shift to increasing alertness, and then to drift back to a sedated state. This potential for acute clinical transition can be challenging to nurses of all levels, even for expert nurses.

Design: Interpretive phenomenology.

Methods: Twenty expert Post-Anesthetic Care Unit nurses, with more than 7 years of nursing experience, participated in qualitative interviews regarding their lived experiences. Interviews were analysed using a modified seven-stage process for interpretation by Diekelmann, Allen and Tanner. The manuscript was developed utilising the COREQ guidelines for reporting qualitative studies.

Results: Four themes identified through the participant's stories were recognising every patient is different, engaging in iterative knowing, walking a fine line, and looking beyond and anticipating. This study identified a constitutive pattern of interpreting sedation by integrating practical understanding and anticipating beyond.

Conclusions: This study indicates a deeper complexity in the way opioid-induced sedation is assessed and balanced with pain management by nurses in the Post-Anesthetic Care Unit.

Relevance To Practice: Nurses in the study adapted their practices around pain management with opioids, in response to their patient's level of sedation; incorporating practices such as giving small, incremental doses and changing the drug. Nurses valued the importance of having "eyeballs on everybody" and being ready to meet the needs of their patient. They appreciate the time to watch and wait for their patient to respond, to better judge the result of their interventions.
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http://dx.doi.org/10.1111/jocn.14672DOI Listing
January 2019

Validation of fitness tracker for sleep measures in women with asthma.

J Asthma 2019 07 24;56(7):719-730. Epub 2018 Aug 24.

e Department of Medicine, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo , Buffalo , NY , USA.

Objective: Nighttime wakening with asthma symptoms is a key to assessment and therapy decisions, with no gold standard objective measure. The study aims were to (1) determine the feasibility, (2) explore equivalence, and (3) test concordance of a consumer-based accelerometer with standard actigraphy for measurement of sleep patterns in women with asthma as an adjunct to self-report.

Methods: Panel study design of women with poorly controlled asthma from a university-affiliated primary care clinic system was used. We assessed sensitivity and specificity, equivalence and concordance of sleep time, sleep efficiency, and wake counts between the consumer-based accelerometer Fitbit Charge™ and Actigraph wGT3X+. We linked data between devices for comparison both automatically by 24-hour period and manually by sleep segment.

Results: Analysis included 424 938 minutes, 738 nights, and 833 unique sleep segments from 47 women. The fitness tracker demonstrated 97% sensitivity and 40% specificity to identify sleep. Between device equivalence for total sleep time (15 and 42-minute threshold) was demonstrated by sleep segment. Concordance improved for wake counts and sleep efficiency when adjusting for a linear trend.

Conclusions: There were important differences in total sleep time, efficiency, and wake count measures when comparing individual sleep segments versus 24-hour measures of sleep. Fitbit overestimates sleep efficiency and underestimates wake counts in this population compared to actigraphy. Low levels of systematic bias indicate the potential for raw measurements from the devices to achieve equivalence and concordance with additional processing, algorithm modification, and modeling. Fitness trackers offer an accessible and inexpensive method to quantify sleep patterns in the home environment as an adjunct to subjective reports, and require further informatics development.
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http://dx.doi.org/10.1080/02770903.2018.1490753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522318PMC
July 2019

Sedation scales: Do they capture the concept of opioid-induced sedation?

Nurs Forum 2018 Oct 27;53(4):399-405. Epub 2018 Jun 27.

School of Nursing, University at Buffalo (SUNY Buffalo), Buffalo, NY.

Aim: The purpose of this study was to explore the concept of opioid-induced sedation and how nurses define and measure sedation in the hospital setting.

Background: Opioid medications are the primary treatment for acute pain in the postoperative setting. One of the most serious side effects of opioid therapy is excessive sedation and respiratory depression. Nurses have the responsibility of providing effective pain management, while keeping the patient safe from adverse sedation and respiratory depression. Thus, the assessment of sedation becomes an integral part of the nurses' responsibilities.

Review Method: A review of the literature on the concept of opioid-induced sedation, and how it is measured by nurses in the hospital setting was performed using the Walker and Avant's (2011) framework.

Results: Sedation is an ambiguous concept that challenges nurse's critical thinking skills. The linear sedation scales can assist with the measurement of sedation, but may lack sensitivity and specificity in detecting the small changes on the continuum of levels of consciousness. Additionally, the scales may not capture the entire aspects of the concept of sedation.

Conclusions: Sedation, as defined by the linear sedation scales is limiting nurses' appreciation of the small changes in level of cognition as well as consciousness that occurs as an adverse and potentially dangerous side effect of opioid medications used for acute pain management. Through developing a better understanding of sedation as a clinical concept, nurses may enhance their clinical skillset in safer postoperative pain management. Additionally, linear sedation scales could be further developed to better capture all aspects of sedation.
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http://dx.doi.org/10.1111/nuf.12266DOI Listing
October 2018

Current Ketamine Practice: Results of the 2016 American Society of Pain Management Nursing Survey on Ketamine.

Pain Manag Nurs 2018 06;19(3):222-229

School of Nursing, University at Buffalo, Buffalo, New York.

Background: Ketamine is increasingly utilized for a variety of pain management challenges. Audience comments from a ketamine presentation at the 2015 American Society of Pain Management Nursing (ASPMN) Conference reflected wide variation in ketamine practices as well as barriers to use.

Aim: The goal was to gain a greater understanding of ASPMN member practice patterns and barriers related to ketamine as adjunctive therapy for pain management.

Design: A questionnaire survey design was used.

Settings: Respondents represented 35 states and 2 countries.

Participants: The participants were 146 respondents from ASPMN membership (1,485 members).

Methods: The survey was distributed by ASPMN on SurveyMonkey. Practice setting and ketamine administration practices were assessed with areas for comments. Results were reviewed using frequencies to describe responses and formatted into tables. Comments were individually reviewed and grouped into common themes.

Results: Administration of ketamine as an analgesic was reported by 63% of respondents. Continuous intravenous ketamine infusions were the most common route of administration (65%); however, wide variability in dosing and length of therapy was reported. A wide variety of practices and challenges related to ketamine utilization were noted.

Conclusions: Numerous studies have indicated the analgesic benefits of ketamine in pain management. The lack of practice standardization has created challenges to its consistent use and outcome measurement. Additionally, the off-label use of ketamine for pain management creates its own unique challenges. However, given the current national climate with intense focus on pain management, interdisciplinary practitioners have an ideal opportunity to evaluate ketamine's use in a comprehensive approach to pain management.
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http://dx.doi.org/10.1016/j.pmn.2018.02.063DOI Listing
June 2018

Perioperative Implementation of Noninvasive Positive Airway Pressure Therapies.

Respir Care 2018 Apr 16;63(4):479-487. Epub 2018 Jan 16.

Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.

Noninvasively applied positive airway pressure therapy (PAP) is available in 3 basic modes: continuous positive airway pressure (CPAP), bi-level positive airway pressure (BPAP), and adaptive servo-ventilation. These are in widespread use in home and hospital settings to treat a variety of disorders of ventilation or gas exchange, including obstructive sleep apnea, sleep-related hypoventilation, periodic breathing, acute and chronic hypercapnic respiratory failure, and acute respiratory failure. They are increasingly being used perioperatively to prevent or treat upper airway obstruction, hypoventilation, and periodic breathing, and they have been found to improve postoperative outcomes in the case of obstructive sleep apnea. An impediment to their use in this setting is a lack of familiarity with their application by hospital clinical staff. This review describes the modes of PAP therapy available, their indications, how therapy is initiated, how efficacy is assessed, common problems encountered with its use, and how these problems can be addressed.
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http://dx.doi.org/10.4187/respcare.05730DOI Listing
April 2018

Common meanings of good and bad sleep in a healthy population sample.

Sleep Health 2016 09 30;2(3):253-259. Epub 2016 Jul 30.

University at Buffalo, School of Nursing, 314 Wende Hall, 3435 Main Street, Buffalo, NY 14214.

Objectives: The study's purpose was to understand the common meanings and shared practices related to good and bad sleep from narratives of a sample of healthy participants.

Design: Interpretive phenomenology was the approach to analyze narratives of the participants' everyday experiences with sleep. Participants were interviewed and asked to describe typical good and bad nights' sleep, what contributes to their sleep experience, and the importance of sleep in their lives. Team interpretations of narratives identified common themes by consensus.

Setting: Medium sized city in New York State (upper west region).

Participants: A sample of 30 healthy participants were from a parent study (n=300) on testing the sleep questions from the Behavioral Risk Factor Surveillance System from the Centers for Disease Control and Prevention.

Measurements/analysis: Interpretations of good and bad sleep.

Results: Participants described similar experiences of good and bad sleep often directly related to their ability to schedule time to sleep, fall asleep, and maintain sleep. Worrying about life stresses and interruptions prevented participants from falling asleep and staying asleep. Yet, based on current life priorities (socializers, family work focused, and optimum health seekers), they had differing values related to seeking sleep opportunities and strategizing to overcome challenges.

Conclusions: The participants' priorities reflected the context of their main concerns and stresses in life that influenced the importance given to promoting sleep opportunities. Public health messages tailored to life priorities could be developed to promote healthy sleep practices.
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http://dx.doi.org/10.1016/j.sleh.2016.06.004DOI Listing
September 2016

Monitoring Hospitalized Adult Patients for Opioid-Induced Sedation and Respiratory Depression.

Am J Nurs 2017 Mar;117(3 Suppl 1):S27-S35

Carla R. Jungquist is an assistant professor in the University at Buffalo School of Nursing, Buffalo, NY. Kirsten Smith is a clinical nurse specialist at Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia. Kelly L. Wiltse Nicely is an assistant professor of nurse anesthesia in the Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia. Rosemary C. Polomano is a professor of pain practice at the University of Pennsylvania School of Nursing. Contact author: Carla R. Jungquist, Carla R. Jungquist has served on the advisory board of Mallinckrodt Pharmaceuticals; Rosemary C. Polomano has served on the advisory boards of Salix Pharmaceuticals, Daiichi Sankyo, and Mallinckrodt Pharmaceuticals. The authors have disclosed no potential conflicts of interest, financial or otherwise.

: Opioid analgesics are commonly administered to hospitalized patients to treat acute pain, but these drugs put patients at risk for serious adverse events, such as unintended advancing sedation, respiratory depression, and death. Nurses play an important role in keeping patients safe by making clinical decisions about the frequency and intensity with which patients receiving IV and epidural opioids should be monitored. To make sound clinical judgments, nurses must be aware of the factors that place patients at elevated risk for adverse opioid-related effects and know how to screen and assess patients for these risks. The authors review the literature on unintended advancing sedation and respiratory depression associated with opioid administration and present evidence-based recommendations for clinical decision making and patient monitoring, using both nursing assessments and electronic technologies.
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http://dx.doi.org/10.1097/01.NAJ.0000513528.79557.33DOI Listing
March 2017

Multimodal Analgesia for Acute Postoperative and Trauma-Related Pain.

Am J Nurs 2017 Mar;117(3 Suppl 1):S12-S26

Rosemary C. Polomano is a professor of pain practice at the University of Pennsylvania School of Nursing, Philadelphia. Mechele Fillman is an NP for the acute pain service in the Division of Pain Medicine at Stanford Hospital and Clinics, Stanford, CA. Nicholas A. Giordano is a PhD student and Hillman Scholar in Nursing Innovation at the University of Pennsylvania School of Nursing. April Hazard Vallerand is associate dean for research and director of the PhD program at Wayne State University College of Nursing, Detroit. Kelly L. Wiltse Nicely is an assistant professor of nurse anesthesia in the Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing. Carla R. Jungquist is an assistant professor in the University at Buffalo School of Nursing, Buffalo, NY. Contact author: Rosemary C. Polomano, Rosemary C. Polomano has served on the advisory boards of Salix Pharmaceuticals, Daiichi Sankyo, and Mallinckrodt Pharmaceuticals; April Hazard Vallerand is on the speaker's bureaus of AstraZeneca and Purdue Pharma and is a consultant for Shionogi, Inc.; and Carla R. Jungquist has served on the advisory board of Mallinckrodt Pharmaceuticals. The authors have disclosed no potential conflicts of interest, financial or otherwise.

: Multimodal analgesia, which combines analgesic drugs from different classes and employs analgesic techniques that target different mechanisms of pain, is recommended in the treatment of acute postoperative and trauma-related pain because its synergistic effect maximizes pain relief at lower analgesic doses, thereby reducing the risk of adverse drug effects. Using a case-based approach, this article reviews various multimodal analgesic therapies used in the treatment of acute pain; discusses their benefits; and summarizes findings from related research, recommendations from evidence-based practice guidelines, and expert consensus reports.
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http://dx.doi.org/10.1097/01.NAJ.0000513527.71934.73DOI Listing
March 2017

Assessing and Managing Acute Pain: A Call to Action.

Am J Nurs 2017 Mar;117(3 Suppl 1):S4-S11

Carla R. Jungquist is an assistant professor in the University at Buffalo School of Nursing, Buffalo, NY. April Hazard Vallerand is associate dean for research and director of the PhD program at Wayne State University College of Nursing, Detroit. Corinna Sicoutris is associate director of advanced practitioners at the Hospital of the University of Pennsylvania, Philadelphia. Kyung N. Kwon is research manager in the Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation, Rockville, MD. Rosemary C. Polomano is a professor of pain practice at the University of Pennsylvania School of Nursing, Philadelphia. Contact author: Carla R. Jungquist, Carla R. Jungquist has served on the advisory board of Mallinckrodt Pharmaceuticals; April Hazard Vallerand is on the speaker's bureaus of AstraZeneca and Purdue Pharma and is a consultant for Shionogi, Inc.; Rosemary C. Polomano has served on the advisory boards of Salix Pharmaceuticals, Daiichi Sankyo, and Mallinckrodt Pharmaceuticals. The authors have disclosed no potential conflicts of interest, financial or otherwise.

: Acute pain, which is usually sudden in onset and time limited, serves a biological protective function, warning the body of impending danger. However, while acute pain often resolves over time with normal healing, unrelieved acute pain can disrupt activities of daily living and transition to chronic pain. This article describes the effects of unrelieved acute pain on patients and clinical outcomes. The authors call on nurses to assess and manage acute pain in accordance with evidence-based guidelines, expert consensus reports, and position statements from professional nursing organizations in order to minimize the likelihood of its becoming chronic.
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http://dx.doi.org/10.1097/01.NAJ.0000513526.33816.0eDOI Listing
March 2017

Foreword.

Am J Nurs 2017 Mar;117(3 Suppl 1):S3

This special supplement examines and summarizes the current state of the science on acute pain management and its practice.
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http://dx.doi.org/10.1097/01.NAJ.0000513525.26192.18DOI Listing
March 2017

Revisions to the Behavioral Risk Factor Surveillance System Sleep Questions.

J Clin Sleep Med 2016 12 15;12(12):1585-1592. Epub 2016 Dec 15.

University of Buffalo, Buffalo, NY.

Study Objectives: To revise and enhance the current Behavioral Risk Factor Surveillance System (BRFSS) sleep questions for detection of sleep/wake disorders that contribute to health burden.

Methods: A descriptive qualitative design was used to guide the investigation. The three methods were (1) a review of the current evidence on sleep related screening questions (including the results from the parent study validating the current BRFSS questions), (2) interviews with sleep experts about the questions they use in their clinical practice to screen for sleep problems, and (3) interviews with lay people to discuss contextual meanings, feelings, and beliefs about sufficient and restful sleep and not feeling rested.

Results: Recommendations for revisions of the current BRFSS questions.

Conclusions: The current BRFSS questions should be refined to better screen for sleep disorders.
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http://dx.doi.org/10.5664/jcsm.6336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155199PMC
December 2016

Sleep disturbance in patients with chronic concussive effects.

Concussion 2016 Dec 1;1(3):CNC15. Epub 2016 Jun 1.

Department of Psychiatry, University at Buffalo, Buffalo, NY, USA.

Aim: Sleep disturbance is relatively overlooked in concussion treatment although sleep disorders may prolong or exacerbate symptoms after a concussion. We looked at the incidence of both sleep disturbance and postconcussion symptoms in a sample of recently concussed individuals.

Methods & Results: We evaluated scores on the insomnia severity index (ISI) and postconcussion symptom scale (PCSS) in 96 participants with persistent symptoms. Sleep disturbance significantly contributed to the severity of postconcussive symptoms and length of recovery; this effect was less pronounced in athletes.

Conclusion: These results suggest a relationship between sleep problems and the time course of recovery from concussive injury. Clinicians who regularly treat concussion would benefit from a more thorough consideration of sleep function in the assessment of postconcussive symptoms.
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http://dx.doi.org/10.2217/cnc-2016-0002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6093943PMC
December 2016

Questionnaires that screen for multiple sleep disorders.

Sleep Med Rev 2017 04 27;32:37-44. Epub 2016 Feb 27.

University of Pennsylvania, Behavioral Sleep Medicine Program, Department of Psychiatry, USA; University of Pennsylvania, School of Nursing, USA.

The goal of this review was to identify, describe, and evaluate the existing multiple sleep disorders screening questionnaires for their comprehensiveness, brevity, and psychometric quality. A systematic review was conducted using Medline/PubMed, cumulative index to nursing & allied health literature, health and psychosocial instruments and the "grey literature". Search terms were "sleep disorders, screening, questionnaires, and psychometrics". The scope of the search was limited to English language articles for adult age groups from 1989 through 2015. Of the n = 2812 articles identified, most were assessment or treatment guideline reviews, topical reviews, and/or empirical articles. Seven of the articles described multiple sleep disorders screening instruments. Of the identified instruments, two questionnaires (the Holland sleep Disorders questionnaire and sleep-50) were evaluated as comprehensive and one questionnaire (the global sleep assessment questionnaire [GSAQ]) was judged to be both comprehensive and efficient. The GSAQ was found to cover four of the six core intrinsic disorders, sleep insufficiency, and daytime sequela with 11 questions. Accordingly, the GSAQ is the most suitable for application as a general sleep disorders screener. Additional work is required to validate this instrument in the context of primary care. Finally, the future development of multiple sleep disorders screening questionnaires should not only cover all six intrinsic sleep disorders but also acquire some basic demographic information (age, sex, body mass index, presence/absence of bed partner, work status and shift) and some limited data regarding sleep sufficiency and the daytime consequences of sleep disturbance.
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http://dx.doi.org/10.1016/j.smrv.2016.02.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543842PMC
April 2017

Avoiding Adverse Events Secondary to Opioid-Induced Respiratory Depression: Implications for Nurse Executives and Patient Safety.

J Nurs Adm 2016 Feb;46(2):87-94

Author Affiliations: Assistant Professor (Dr Jungquist), School of Nursing, University at Buffalo, New York; Assistant Professor of Anaesthesia (Dr Correll), Harvard Medical School, Boston, Massachusetts; Professor and Chair (Dr Fleisher), Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia; Professor and Chairman (Dr Gross), Department of Anesthesiology, University of Connecticut School of Medicine, Farmington; Assistant Professor (Dr Gupta), Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee; Pain Management Clinical Consultant (Ms Pasero), El Dorado Hills, California; President (Dr Stoelting), Anesthesia Patient Safety Foundation, Indianapolis, Indiana; Professor of Pain Practice (Dr Polomano), University of Pennsylvania School of Nursing, Philadelphia.

Background: Guidelines with recommendations for monitoring type and timing of hospitalized patients for opioid-induced respiratory depression have been published, yet adverse events continue to occur.

Objective: This study reports on the monitoring practices of 8 hospitals that volunteered to pilot test a Centers for Medicare & Medicaid Services e-quality measure that was under development. Recommendations for nurse executives are provided to support patient safety.

Methods: Data on monitoring practices were collected retrospectively from the electronic medical records at 8 hospitals on all patients receiving intravenous (IV) opioids for more than 2.5 continuous hours via patient-controlled analgesia (PCA). Analysis included the percentage of patients who were monitored according to specific standards developed by a panel of technical experts with comparisons of naloxone use to monitoring practices.

Results: Recommended patient assessments occurred in only 8.3% of the patients. No patients who were assessed at least every 2.5 hours received naloxone.

Conclusions: Care for patients receiving IV PCA is lacking in adherence to latest safety standards. Nurse executives must implement structures and processes to promote vigilance with evidence-based monitoring practices.
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http://dx.doi.org/10.1097/NNA.0000000000000301DOI Listing
February 2016

Validation of Capturing Sleep Diary Data via a Wrist-Worn Device.

Sleep Disord 2015 15;2015:758937. Epub 2015 Dec 15.

University at Buffalo School of Nursing, University at Buffalo, South Campus, 202 Beck Hall, 3435 Main Street, Buffalo, NY 14214, USA.

Paper sleep diaries are the gold standard for assessment of sleep continuity variables in clinical practice as well as research. Unfortunately, paper diaries can be filled out weekly instead of daily, lost, illegible or destroyed; and are considered out of date according to the newer technology savvy generations. In this study, we assessed the reliability and validity of using a wrist-worn electronic sleep diary. Design. A prospective design was used to compare capturing 14 days of sleep continuity data via paper to a wrist-worn electronic device that also captured actigraphy data. Results. Thirty-five healthy community dwelling adults with mean (sd) age of 36 (15), 80% Caucasians, and 74% females were enrolled. All sleep continuity variables via electronic and paper diary capture methods were significantly correlated with moderate, positive relationships. Assessment of validity revealed that electronic data capture had a significant relationship with objective measure of sleep continuity variables as measured by actigraphy. Paper diary variables were not significantly associated with objective measures. Conclusions. The use of a wrist-worn device to capture daily sleep diary data is as accurate as and for some variables more accurate than using paper diaries.
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http://dx.doi.org/10.1155/2015/758937DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4693024PMC
January 2016

Validation of the Behavioral Risk Factor Surveillance System Sleep Questions.

J Clin Sleep Med 2016 Mar;12(3):301-10

University of Buffalo, Buffalo, NY.

Study Objectives: leep problems may constitute a risk for health problems, including cardiovascular disease, depression, diabetes, poor work performance, and motor vehicle accidents. The primary purpose of this study was to assess the validity of the current Behavioral Risk Factor Surveillance System (BRFSS) sleep questions by establishing the sensitivity and specificity for detection of sleep/ wake disturbance.

Methods: Repeated cross-sectional assessment of 300 community dwelling adults over the age of 18 who did not wear CPAP or oxygen during sleep. Reliability and validity testing of the BRFSS sleep questions was performed comparing to BFRSS responses to data from home sleep study, actigraphy for 14 days, Insomnia Severity Index, Epworth Sleepiness Scale, and PROMIS-57.

Results: Only two of the five BRFSS sleep questions were found valid and reliable in determining total sleep time and excessive daytime sleepiness.

Conclusions: Refinement of the BRFSS questions is recommended.
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http://dx.doi.org/10.5664/jcsm.5570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773626PMC
March 2016

Instituting best practice for monitoring for opioid-induced advancing sedation in hospitalized patients.

Worldviews Evid Based Nurs 2014 Dec 23;11(6):350-60. Epub 2014 Sep 23.

Assistant Professor, University at Buffalo, the State University of New York, Buffalo, NY, USA.

Background: Adverse events related to opioid-induced unintended advancing sedation and respiratory depression in hospitalized patients are occurring with increased frequency, and these adverse events can have a negative impact on quality and cost outcomes.

Aim: The goal of this paper is to inform nurses on best practices for preventing opioid-induced advancing sedation and respiratory depression, and to inform nurse leaders on implementation strategies to guide change in policies and practice.

Methods: This paper presents an evidenced-based systematic approach for organizations to use in implementing strategies to reduce adverse events secondary to opioid-induced advancing sedation and respiratory depression in the hospitalized adult patient.

Results: An action-oriented framework was developed based on the authors' experiences, strategies recommended by the Institute for Healthcare Improvement (IHI), the National Association of Healthcare Quality (NAHQ), and expert consensus-based best monitoring practices.

Linking Evidence To Action: Nurse executives and nurse managers assume accountability for ensuring that patient care is aligned with the best evidence, practices, and regulatory mandates. The framework presented in this paper can help prevent opioid-induced advancing sedation and respiratory depression, and assist nurse leaders in implementation strategies to guide policies and practice.
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http://dx.doi.org/10.1111/wvn.12061DOI Listing
December 2014
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