respiration and mechanical monitoring of respira-tion, such as pulse oximetry and capnography, were reviewed.
The ASPMN Guidelines Expert Consensus Panelprovided summary recommendation statementsfor each of the four subcategories and strategiesfor implementation of the recommendations (key recommendations in Table 2 ).
The strategiesdescribe the establishment of supportive policiesand procedures; evaluation and improvement of documentation and interdisciplinary communica-tion;trackingofoutcomes;andnursing,prescriber,and patient education.
The ASPMN Guidelines on Monitoring for Opioid-induced Sedation and Respiratory Depressionprovide evidence-based recommendations for thecare of patients receiving opioid analgesics for the treatment of pain in the acute care setting.They reﬂect the uniqueness of patients, autonomy in nurses’ judgments and decision making, andfoundations of professional nursing practice. Iden-tiﬁed limitations were the lack of RCTs examiningoutcomes associated with monitoring techniquesandthelackofstandardizedwell-deﬁnedoutcomesacross studies.
Table 1. American College of Cardiology Foundation and American Heart Assocation Task Force on Practice GuidelinesMethodology *
Class I Conditions for which there is evidenceand/or general agreement that a givenprocedure or treatment is useful andeffective: beneﬁt
risk.Class II Conditions for which there is conﬂictingevidence and/or a divergence of opinion about the usefulness/efﬁcacy of a procedure or treatment.IIa Weight of evidence/opinion is in favor of usefulness/efﬁcacy: beneﬁt
risk.IIb Usefulness/efﬁcacy is less wellestablished by evidence/opinion:beneﬁt
risk.Class III Conditions for which there is evidenceand/or general agreement that theprocedure/treatment is not useful/ effective and in some cases may beharmful: risk
beneﬁt.*Based on data from reference 3.
Table 2. Key Recommendation Statements*
Individual risk 1. Comprehensive preadmission, admission, and preopioid therapy assessments are recommended to identify anddocument existing conditions, disease states, and other factors that may place patients at a risk of unintended ad- vancing sedation and respiratory depression with opioid therapy (Class I). A. Risk factors may include but are not limited to age above 55 years, preexisting pulmonary disease, known or suspectedsleep-disorderedbreathingproblems,anatomicalorairwayabnormalities,andcomorbidities (systemicdisease, renal, or hepatic impairment) or presurgical or preprocedural ASA status higher than 2.
B. Preoperative ASA Physical Status Classiﬁcation System
category status assigned by the anesthesia provider is animportant factor in determining level of care after surgery.C. Interpretation of evidence-based assessment criteria/tools can be useful in determining patient risk status (eg,results of sleep studies, history of witnessed apneas, and screening with the STOP-Bang questionnaire).D. Develop medical record forms that include risk assessment criteria and/or information to facilitate documenta-tion.2. Nurses should communicate all pertinent information regarding patients’ risks during shift report and across alltransitionsincarefromprehospitalizationtodischargetoensurethathealthcareprovidersareinformedofpotentialrisks (Class I).3. It is reasonable that organizations develop and implement polices and procedures that deﬁne the scope of patientrisk assessment practices, requirements for documentation, standards of care, and accountability of health careproviders for ensuring safe patient care with opioid therapy (Class IIa).