Joint Commission Issues Sentinel Alert for Safe Opioid Use
The Joint Commission has issued a sentinel event alert focused on hospitals' safe use of opioids.
Opioid analgesics rank among the drugs most frequently associated with adverse drug events. Opioids such as morphine, oxycodone and methadone can cause serious complications, including slow breathing to dangerous levels, and even death. The reasons for such adverse events include dosing errors, improper monitoring of patients and interactions with other drugs.
The Joint Commission recommends that healthcare organizations take the following actions:
• Implement effective practices, such as monitoring patients who are receiving opioids on an ongoing basis, use pain management specialists or pharmacists to review pain management plans, and track opioid incidents.
• Use available technology to improve prescribing safety of opioids such as creating alerts for dosing limits, using tall man lettering in electronic ordering systems, using a conversion support system to calculate correct dosages and using patient-controlled analgesia.
• Provide education and training for clinicians, staff and patients about the safe use of opioids.
• Use standardized tools to screen patients for risk factors such as oversedation and respiratory depression.
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