Iatrogenic Risk FactorsIatrogenesis

Iatrogenic Risk Factors
Iatrogenesis is the development of complications directly related
to receiving treatment. Iatrogenic factors during opioid
administration are environmental and pain therapy-related circumstances
in the hospital workplace that predispose a patient
to increased risk of unintended advancing sedation and respiratory
depression (Jarzyna et al., 2011). Specific areas of focus are
opioid delivery modality, coadministration of sedating drugs,
timing and environment, communication, nurse staffing and
education, and monitoring practices (see Table 3).
Nurses at the bedside are in the best position to prevent adverse
events secondary to opioid-induced advancing sedation
and respiratory depression by using critical thinking skills and
analyzing and trending multiple outcomes such as respiratory
rate, sedation levels, and measurements such as pulse oximetry
and ETCO2 over time. Nurse leaders have the responsibility
to ensure that their nursing staff is properly trained, there
are safe nurse-to-patient ratios, and nurses have the needed
resources for safe patient care. The recent trend in hospitals
purchasing advanced monitoring systems such as integrating
Modified Early Warning Systems (MEWS) allows clinicians to respond more quickly and efficiently to circumvent the need
for activating code blues in response to ensuing or actual cardiopulmonary
arrests (Eckstrand et al., 2009; Maupin, Roth,
& Krapes, 2009). These systems have also demonstrated reductions
in mortality rates (Eckstrand et al., 2009; Maupin
et al., 2009). However, this equipment is very expensive and
has not proven to be more effective than a nurse-assessed level
of sedation that can detect early signs of opioid-induced events
(Eckstrand et al., 2009; Maupin et al., 2009).