1. An Update: Joint Commission Standards and CMS Regulations OR Manager Annual Meeting John R. Rosing, MHA, FACHE Jennifer Cowel, RN, MBA Patton Healthcare Consulting September 23, 2013 Baltimore, Maryland 1

2. Speaker John R. Rosing, MHA, FACHE  Accreditation and Regulatory Compliance Consultant  Vice President and Principal Patton Healthcare Consulting  262-242-3631  JohnRosing@PattonHC.com 2

3. Sentinel Event Alert #49 Safe Opioid Use - Risk Factors Hx of sleep apnea or snoring Smoker Morbid obesity Older age (>80 has almost 9X > risk) No recent opioid use///opioid habituation Concomitant use of benzodiazepines, antihistamines, sedatives or other CNS depressants Post surgical, notably abdominal///thoracic Longer anesthesia times Pre-existing pulmonary or cardiac disease 3

4. Safe Opioid Use State Board of Medicine – Massachusetts – 27 incident reports since 2007 – 77% concomitant morphine or lorazepam – 23% of patients were obese – 19% had sleep apnea – 15% asthma – 15% some other chronic respiratory condition – > age 60, female, most likely on night shift 4

5. Safe Opioid Use – Actions Taken Eliminate range orders for dose and time Lower dose hydromorphone purchased Eliminate Pyxis override for hydromorphone Educate staff on 8:1 dose conversion between morphine and hydromorphone Specific privileging for hydromorphone ordering Discourage hydromorphone use for outpatients Closely monitor patients with known risk factors 5

6. Safe Opioid Use - Key Recommendations Use conversion support systems when converting from one opioid to another or one route of administration to another. Use a sedation monitoring scale such as RASS, Pasero POSS or University of MI. As with any SEA, have paper trail showing consideration of recommendations and actions taken, plus subsequent QAPI 6

7. QUESTIONS? JohnRosing@PattonHC.com JenCowel@PattonHC.com Kurt@PattonHC.com Please visit and bookmark www.pattonhc.com www.pattonhc.com 7