American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions
American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions
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DOI：
10.1016/j.pmn.2019.06.007
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发表时间：
2020-02-01
影响因子：
1.7
通讯作者：
Polomano, Rosemary C.
中科院分区：
文献类型：
--
作者：
Jungquist, Carla R.;Quinlan-Colwell, Ann;Polomano, Rosemary C.
目的：本报告提出了最新的证据和专家共识为基础的修订ASPMN 2011年指南，通知跨专业的临床决策为住院成人接受阿片类镇痛药。设计：系统回顾literature.Methods：一个由14名成员组成的专家小组负责审查和分级的力量发表在同行评审的期刊上的科学证据，并修订ASPMN 2011年现有的指南。专家组成员根据证据的强度制定建议，并通过讨论、重新评估证据和必要时的多数表决达成共识。使用美国麻醉医师协会证据类别对证据强度进行分级和分类。建议进行了严格的审查ASPMN成员以及外部reviews.Results：2011年的指南被发现仍然是相关的临床实践，但新的证据证实完善和更具体的电子监测建议。修订后的指南将风险因素分为三类：患者特异性，治疗相关性和护理环境。具体建议使用电子monitoringscanned.Conclusions：所有的住院患者，给予阿片类药物治疗急性疼痛的阿片类药物诱导的推进镇静和呼吸抑制的风险，但有些患者是在高风险，需要额外的警惕，以防止不良事件。所有患者都必须评估风险水平。适应计划的护理和监测策略应驱动迭代重新评估根据水平的risk.Nursing实践的影响：阿片类药物仍然是一个主要组成部分，在管理急性疼痛。临床医生对安全有效的疼痛管理负有主要责任。基于证据的监测策略可以提高阿片类药物的患者安全性。(C)2020年美国疼痛管理护理学会。爱思唯尔公司出版All rights reserved.
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. (C) 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.