Measure ID
MED-01
Domain
Description

Percentage of patients requiring the use of nalaxone or flumazenil for reversal.

Measure Type
Outcome
Available for Provider Feedback
No - Departmental Only
Threshold
<5%
Rationale

Opioid and/or benzodiazepine administration can lead to respiratory depression, brain damage, and even death.   Judicious use of opioids for patients that have planned extubation at end of case can avoid use of reversal agents and their side effects.  For patients not meeting extubation requirements due to opioids or benzodiazepines, waiting until the effects wear off is preferable to reversal administration.

Measure Time Period
Inclusions

All patients receiving opioids or benzodiazepines intraoperatively.

Exclusions
  • ASA 5 & 6 including Organ Procurement (CPT: 01990)
  • Cases where naloxone or flumazenil is administered before the first dose of opioid/benzodiazepine
  • Patients not given opioids or benzodiazepines during the intraoperative period
  • Patients that are still intubated at anesthesia end (as determined by no Extubation Time recorded for the case)
  • ECT
Success Criteria

Administration of naloxone or flumazenil was not required for the case.

Special Considerations: If naloxone was given as an infusion AND as a bolus, the case is flagged due to the bolus. If naloxone is only given as an infusion, then the case is still evaluated for flumazenil. Patients receiving naloxone as in infusion indicate naloxone is being infused for pruritus for neuraxial technique.

Other Measure Details

MED 01 is an outcome measure that identifies intraoperative medication overdose by monitoring the administration of opioids and/or benzodiazepines and the administration of reversal agents: flumanzenil and naloxone.

*This measure will include only valid MPOG cases as defined by the Is Valid Case phenotype.

Risk Adjustment

Pending.

Provider Attribution

Primary Provider - Provider(s) present for longest duration of the case per staff role.

MPOG Concept Used

Opioid

  • 10306 Morphine
  • 10186 Fentanyl
  • 10219 Hydromorphone
  • 10414 Sufentanil

Benzodiazepine

  • 10301 Midazolam
  • 10154 Diazepam

Reversal

  • 10191 Flumazenil
  • 10312 Naloxone
MPOG Phenotypes Used
References
  1. Lee LA, Caplan RA, Stephens LS, Posner  KL, Terman GW, Voepel-Lewis T, Domino KB. Postoperative opioid- induced respiratory depression: A closed claims analysis. Anesthesiology. 2015;122(3):659-665.
  2. Ramachandran SK, Haider N, Saran KA, Mathis M, Kim J, Morris M, O’Reilly M. Life-threatening critical respiratory events: A retrospective study of postoperative patients found unresponsive during analgesic therapy. J Clin Anesth. 2011;23:207–13.
Measure Authors

 Measure Author

 Instiutution

 Nirav Shah, MD

 University of Michigan

 Jaime Osborne, MSN, RN

 University of Michigan

 Genevieve Bell

 University of Michigan

 Sachin Kheterpal, MD

 University of Michigan

 MPOG Quality Committee

 University of  Michigan

 

Measure Reviewer(s)
Next Review: 2025
 Date Reviewed  Reviewer  Institution  Summary  QC Vote

11/28/2022

Karen Domino

Univeristy of Washington

Review

  Modify

Version
Published: 11/2015 / Retired: 2024
 Date  Criteria  Revision
4/8/2024 All Measure Retired