University of Colorado Hospital Nursing Practice Guideline

Emergency Department: Pulse Oximetry Monitoring of Patients Receiving

Intravenous Opioids

Effective Date:

Replaces Policy/Guideline:

Approval Date: 07/2015

Approved By:
Nursing Practice Guidelines Subcommittee
Emergency Department Operations
Committee

Introduction:
This guideline is for Emergency Department patients receiving IV opioids to be placed on pulse
oximetry monitoring.
Scope:
I.
II.

Healthcare professional in the Emergency Department providing primary care for

patients
All healthcare professional floating in the emergency department

Practice Guideline Details:

I. For patients in the Emergency Department who receive IV opioids pulse oximetry monitoring
will be initiated and followed:
A. Total doses exceeding IV Morphine Sulfate 10mg or IV Hydromorphone 1mg or
100mcg fentanyl.
B. When IV opioids of any dose are administered to a patient the nurse deems is at
increased risk including
1. Age >55 years
2. Obesity (BMI>30kg/m)
3. Preexisting pulmonary dysfunction, e.g. COPD
4. Smoker (>20 pack-years)

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Emergency Department: Pulse Oximetry monitoring of patients receiving IV opioids
5. History of naloxone administration in respiratory depression
6. Patient with renal or liver insufficiency
7. Total morphine equivalent of 50mg or greater within 24 hours including home
meds.
C. IV Opioids in combination with:
1. Barbituates, benzodiazepines
2. Intoxicated patients
3. Other sedating medications
II

. Pulse oximetry monitoring can be discontinued when:

A. Five hours have passed since last administration of IV Hydromorphone or
Morphine
B. Two hours have passed since last administration of Fentanyl
C. The patient is to be transferred to an inpatient unit and the inpatient orders do not
include pulse oximetry
D. Upon discharge from the Emergency Department

Related Policies and Nursing Practice Guidelines:

Moderate Sedation or Analgesia Outside the Operating Room Policy

Definitions:
Healthcare Professional: Any individual who is licensed and/or qualified to practice a health
care profession (for example: physician, nurse, social worker, clinical psychologist, pharmacist,
PT/OT/ST, or respiratory therapist) and is engaged in the provision of care, treatment, or services
as defined by their job description.
References:
American Heart Association's Get with the Guidelines Investigators. (2011). In-Hospital Cardiac
Arrest: Impact of Monitoring and Witnessed Event on Patient Survival and Neurologic
Status at Hospital Discharge. Science Direct, 82, 845-852. (LOE 4)
Chudnofsky, C., Wright, S., Dronen, S., Borron, S., & Wright, M. (1989). The Safetly of
Fentanyl Use in the Emergency Department. Annals of Emergency Medicine, 16(6)61-69.
(LOE 5)
Deitch, K., Rowden, A., Damiron, K., Lares, C., Oqroshidze, N., & Aguilera, E. (2014).
Unrecognized Hypoxia and Respiratory Depression in Emergency Department Patients
Sedated for Psychomotor Agitation: Pilot Study. Western Journal of Emergency
Medicine, 15(4) 430-437.(LOE 4)
Jarzyna, D., Jungquist, C., Pasero, C., Willens, J., Nisbet, A., Oakes, L, (2011). American Society
for Pain Management Nursing Guidelines on Monitoring for Opiod-Induced Sedation and
Respiratory Depression. Pain Management Nursing , 12(3), 118-145. (LOE 1)
2

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Emergency Department: Pulse Oximetry monitoring of patients receiving IV opioids