The Joint Commission


  • Starting in 2018, all Joint Commission-accredited hospitals are required to comply with standards that specifically identify the need for improved monitoring of opioid analgesics patients, for whom the most dangerous adverse effect is known to be respiratory depression
  • Requirement:
    • "The hospital monitors patients identified as being high risk for adverse outcomes related to opioid treatment."
    • “Hospital leadership works with its clinical staff to identify and acquire the equipment needed to monitor patients who are at high risk for adverse outcomes from opioid treatment”
  • Rationale:

The most dangerous adverse effect of opioid analgesics is respiratory depression, and monitoring for respiratory depression is sometimes appropriate. The leadership team should work with clinician leaders to ensure equipment is available to monitor patients deemed highest risk (e.g., patients with sleep apnea, those receiving continuous intravenous opioids, or those on supplemental oxygen)”




"Postoperative opioid-induced respiratory depression is a significant cause of death and brain damage in the perioperative period."

  • Potentially preventable with improvements in monitoring of ventilation, and early response and intervention, particularly within the first 24 hours postoperatively.1




CMS Center for Clinical Standards updated requirements: 

  • Emphasize the need for post-operative monitoring of patients receiving IV opioid medications, regardless of where they are in the hospital.

  • Reflects the need for patient risk assessment and appropriate monitoring during & after medication administration, particularly for post operative pati-ents receiving IV opioid medications, in order to prevent adverse events.2


American Society of Anesthesiologists

  • Practice Guidelines for Postanesthetic Care:

    • "Particular attention should be given to monitoring oxygenation and ventilation"

  • "The Task Force emphasizes that because ventilation and oxygenation are separate though related physiologic processes, monitoring oxygen-ation by pulse oximetry is not a substitute for monitoring ventilatory function."

  • Reflects the need for patient risk assessment and appropriate monitoring during & after medication administration.

  • Particularly useful for post operative patients receiving IV opioid medications in order to prevent adverse events.3



Joint Commission Sentinel Event #49:

Safe use of opioids in hospitals.

  • Inadequate monitoring of patients on opioids identified among root causes.

  • 29% of opioid-related adverse drug events related to improper monitoring of the patient.4




"The Anesthesia Patient Safety Foundation believes that clinically significant, drug-induced respiratory depression in the postoperative period remains a serious patient safety risk that continues to be associated with significant morbidity and mortality."

  • Nearly 30% of post-operative patients and up to 7% of all Medicare patient will suffer from respiratory compromise.

  • $53,000+ cost per respiratory arrest based on Healthgrades

  • Hospital burden exceed $7 Billion annually in the U.S.5


1. Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration: An Updated Report by the American Society of Anesthesiologists Task Force on Neuraxial Opioids and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2016;124(3):535-552.

2. Requirements for Hospital Medication Administration, Particularly Intravenous (IV) Medications and Post-Operative Care of Patients Receiving IV Opioids. Centers for Medicare and Medicaid Services. March 14, 2014; 1-32.

3. Practice Guidelines for Postanesthetic Care. American Society of Anesthesiologists Task Force on Postanesthetic Care. 2013; 1-17.

4. Safe use of opioids in hospitals. Sentinel Event Alert. August 8, 2012;(49):1-5.

5. Weinger MB, Lee LA. No patient shall be harmed by opioid-induced respiratory depression. APSF Newsletter 2011; 26: 21, 26-8.

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