The observation that excessive sedation precedes opioid-induced respiratory depression (Abou Hammoud et al., 2009) indicates that systematic sedation assessment is an essential aspect of the care of opioid-naïve patients receiving opioid therapy (Jarzyna et al., 2011; Nisbet & Mooney-Cotter, 2009; Pasero, 2009b, 2013). The importance of monitoring sedation to prevent clinically significant respiratory depression cannot be overemphasized. The American Society for PeriAnesthesia Nurses issued three major practice recommendations surrounding sedation assessment in the perioperative setting: 1) assess and screen patients for individual and iatrogenic risk; 2) assess for unwanted sedation in Phase I and Phase II PACU; and 3) perform an individualized discharge assessment of inpatient postoperative patients (ASPAN, 2014).
Nursing assessment of opioid-induced sedation is convenient, inexpensive, and takes minimal time to perform (Pasero, 2009b). PACU nurses often use scoring systems (e.g., Aldrete) that include level of consciousness to determine readiness for discharge; however, a simple, easy-to-understand sedation scale that includes what should be done at each level of sedation should be used for ongoing assessment of opioid-induced sedation after the patient has been transferred to the clinical unit. The use of such a scale will help to enhance accuracy and consistency of assessment and treatment, will help to monitor trends, and will help to communicate effectively between members of the healthcare team (Kobelt, 2014; Kobelt, Burke, & Renker, 2013). A commonly used sedation scale in PACUs and clinical units is the Pasero Opioid-Induced Sedation Scale (POSS) (Box 5-1) (ASPAN, 2014; Kobelt, 2014; Kobelt, Burke, & Renker, 2013). Note that the POSS links nursing interventions to the various levels of sedation. Research has shown that nurses find this approach helpful in making the appropriate decisions on how to proceed with opioid treatment (Nisbet & Mooney-Cotter, 2009; Kobelt, 2014).
Box 5-1 Pasero Opioid-Induced Sedation Scale (POSS) with Interventions