Safety Innovations: Healthcare System Takes Bold Step with Continuous Monitoring.

Community Health Network prides itself on excellence in clinical care, high standards, continuous drive for improvement, and evidence-based and data-driven practices. Based in Indianapolis, IN, the community healthcare system performs more than 12,600 inpatient surgeries annually. In 2013, Community Health Network noticed a worrisome trend in the data, which showed an increased frequency in interventions for patients experiencing opioid-induced oversedation following inpatient surgery. Clinical leaders and quality assurance and risk management staff acted decisively. With executive support, they began rolling out continuous electronic monitoring for all patients after inpatient surgery, in an effort to safeguard patients from the potentially harmful effects of oversedation. Continuous monitoring was seen as a high-quality practice—one that not many healthcare systems had implemented. Community Health Network now is on track to implement the solution in all five of its six hospitals that perform inpatient surgeries. Continuous monitoring had resulted in a clear turnaround, with marked declines in opioidrelated interventions, including Code Blue rapid response, opioid reversal medications, and transfer of patients to more intensive levels of care. The healthcare system had turned its attention to potential applications of this method to surgical obstetric patients, emergency departments, and procedural areas. Challenge About 10 years ago, Community Health Network began using patient-controlled analgesia (PCA) infusion pumps with some postsurgical patients. PCA allows patients to self-administer their pain relief medication. As long as PCA pumps are used as intended—by patients only, and not by anyone else—they are unlikely to deliver overdoses of medication. Even so, as an extra precaution, the healthcare system also implemented continuous electronic monitoring for all patients on PCA, using capnography. Capnography is the noninvasive monitoring of ventilation as measured by end-tidal CO2—the concentration of CO2 in exhaled breaths. Monitoring end-tidal CO2 detects changes in ventilation and perfusion (blood flow to the lungs) and can detect respiratory depression, which is a sign of oversedation. Typically, end-tidal CO2 monitoring detects respiratory compromise well before it is noticeable to even the most diligently watchful clinicians. This empowers them to intervene well before respiratory distress turns into a crisis. “This is the state of the knowledge,” said Julie Painter, RN, MSN, OCN, clinical nurse specialist at Community Health Network. “The technology is so accurate that it can help clinicians understand what is happening to a patient’s lungs, body, and perfusion long before they stop breathing, so we can intervene.” Safety Innovations Healthcare System Takes Bold Step with Continuous Monitoring