Evaluation of a standardized sedation assessment for opioid administration in the post anesthesia care unit

Abstract

The impact of opioid-related sedation progressing to respiratory depression in the Post Anesthesia Care Unit (PACU) can be extensive; however, there is a paucity of research on the subject of standardized assessment tools to prevent adverse events. The purposes of this study were: (1) to measure the efficacy of a standardized method of assessing sedation and administering opioids for pain management via the Pasero Opioid-Induced Sedation Scale (POSS) with interventions in the PACU; (2) to increase PACU nurses' confidence in assessing sedation associated with opioid administration for pain management and in the quality of care provided in their clinical area; and (3) to facilitate PACU and postoperative clinical unit nurses' communications during patient handoffs regarding safe opioid administration. A quasi-experimental design was used to evaluate the POSS protocol. Two PACUs and six nursing units receiving postsurgical patients in a Midwestern inner-city hospital served as the setting for this research. Medical records were surveyed for outcome data to evaluate the efficacy of the care protocol in two patient cohorts before and after implementation of the POSS protocol. Nurses completed a written survey to identify changes in satisfaction with nurse-to-nurse communication, perceptions of quality of care, and confidence with opioid administration. The final sample included 842 PACU patients and 67 nurses from the PACU and clinical units. The intervention did not significantly change PACU length of stay or amount of administered opioids and patients were noted to be more alert at time of discharge from the PACU. Nurses reported increased perceptions of quality of care and confidence in opioid administration. The findings from this study support the use of the POSS Scale with interventions in the PACU care protocols.