​Because oversedation with opioids can lead to respiratory depression, postanesthesia care unit (PACU) nurses must carefully juggle pain relief, patient satisfaction, and patient safety. An article in the October 2014 Journal of PeriAnesthesia Nursing describes implementation of the Pasero Opioid-Induced Sedation Scale (POSS), a standardized approach to assessing opioid-induced sedation and instituting interventions, in the general and orthopedic PACUs of a 600-bed hospital. On implementation, the PACUs used the POSS to assess patients at three times: during routine 15-minute assessments (which also evaluated vital signs, Aldrete score, and pain intensity), before and after each opioid dose (along with pain intensity ratings), and on PACU discharge. The POSS scores are S ("sleep, easy to arouse"), 1 ("awake and alert"), 2 ("slightly drowsy, easily aroused"), 3 ("frequently drowsy, arousable, drifts off to sleep during conversation"), and 4 ("somnolent, minimal, or no response to verbal or physical stimulation"). Scores of S, 1, or 2 are considered acceptable; the opioid dose may be increased if needed. The scale outlines steps to take for scores of 3 or 4. Documentation reflected high levels of adherence to the protocol, and PACU nurses reported feeling more confident in reducing the risk of oversedation when administering opioids. More patients were awake at discharge, and nurses anecdotally reported that the POSS helped justify withholding further opioid doses when the patient was in pain but experiencing higher levels of sedation. In the same issue, the American Society of PeriAnesthesia Nurses issued a practice recommendation to prevent unwanted sedation, which supports the use of a standardized approach to assessing opioid-induced sedation.

HRC Recommends: Opioid-induced oversedation and respiratory depression are significant patient safety concerns in the PACU, as well as in other areas of a healthcare facility. Risk managers may wish to forward the practice recommendations and article to appropriate individuals and departments and consider whether the organization should adopt a standardized approach to assessing opioid-induced sedation.