• Carla R Jungquist, Ann Quinlan-Colwell, April Vallerand, Heather L Carlisle, Maureen Cooney, Susan J Dempsey, Danielle Dunwoody, Angelika Maly, Kathy Meloche, Ashley Meyers, Jason Sawyer, Navdeep Singh, Denise Sullivan, Chris Watson, and Rosemary C Polomano.
• University at Buffalo, Buffalo, New York. Electronic address: Carlajun@Buffalo.edu.
• Pain Manag Nurs. 2020 Feb 1; 21 (1): 7-25.

ObjectivesThis report presents up-to-date evidence and expert consensus-based revisions to the ASPMN 2011 guidelines that inform interprofessional clinical decision-making for hospitalized adults receiving opioid analgesics.DesignSystematic review of the literature.MethodsA 14-member expert panel was charged with reviewing and grading the strength of scientific evidence published in peer reviewed journals and revising the ASPMN 2011 existing guidelines. Panel members formulated recommendations based on the strength of evidence and reached consensus through discussion, reappraisal of evidence, and voting by majority when necessary. The American Society of Anesthesiologists evidence categories for grading and classifying the strength of the evidence were used. Recommendations were subjected to a critical review by ASPMN members as well as external reviews.ResultsThe 2011 guidelines were found to still be relevant to clinical practice, but new evidence substantiated refinement and more specific recommendations for electronic monitoring. The revised guidelines present risk factors divided into three categories: patient-specific, treatment-related, and environment of care. Specific recommendations for the use of electronic monitoring are delineated.ConclusionsAll hospitalized patients that are administered opioids for acute pain are at risk of opioid induced advancing sedation and respiratory depression, but some patients are at high risk and require extra vigilance to prevent adverse events. All patients must be assessed for level of risk. Adaptations to the plan of care and monitoring strategies should be driven by iterative re-assessments according to level of risk.Nursing Practice ImplicationsOpioid medications continue to be a major component in the management of acute pain. Clinicians have the primary responsibility for safe and effective pain management. Evidence based monitoring strategies can improve patient safety with opioids.Copyright © 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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