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Crozer Incorporates Pasero Score into MAK

Opioids are a treatment cornerstone when it comes to managing pain in hospitals, but there are a number of serious risks that can accompany their use. To address one of these risks, all Crozer-Keystone hospitals are now using the Pasero Opioid-Induced Sedation Scale to help screen patients for opioid-induced respiratory depression.

Effective January 14, nurses began recording a Pasero score along with a pain level score at the time of opioid administration. A second Pasero score is required one hour after drug delivery. Both scores must be recorded in eCare.   

The universal use of the Pasero score – a new Joint Commission requirement – is part of CKHS’s Medication Administration Checking (MAK) system. Its introduction across the health system was based on a recommendation that originated during Vision Day.

“Staff nurses were the driving force behind the system-wide adoption of the Pasero score,” says Noreen Caldwell, RNC, BSN, MSHA, Administrative Director of Nursing and Clinical Support Services, Springfield Hospital. “They performed literature searches and convened with the CKHS informatics nurses to develop recommendations for how, when and where to document the Pasero score.”

According to Caldwell, staff nurses not only developed recommendations but shepherded them from the Medical/Surgical/Behavioral Health Practice Council through Leadership Council for final approval. 

The Pasero score uses a scale of S – 4 with S indicating “sleeping and easy to arouse,” 1 indicating “awake and alert” and 4 indicating “somulent.” A score of 3 or 4 requires immediate attention.

“Opioid-induced respiratory depression is hard to diagnose and is likely to lead to death or anoxic brain injury unless detected promptly,” says Caldwell. “We realized we weren’t universally using the Pasero scores across the health system, so we saw this as an opportunity to improve our performance.”

Historically, hemodynamic monitoring (blood pressure, heart rate, and heart rhythm) has taken center stage in bedside patient assessment. Yet the most common events preceding cardiopulmonary issues are respiratory related.

Typically, the earliest warning signs of physiologic instability reflect respiratory decompensation – tachypnea, bradypnea, hypoxia, hypercarbia, and mental status changes. Using Pasero to monitor respiratory function and level of consciousness will help prevent adverse events in patients receiving opioids and sedatives.

One survey-based study found that the Pasero Scale demonstrated adequate measures of reliability and validity in measuring sedation during opioid administration for pain management. It also found that Pasero has clinical significance in determining the accuracy of clinical assessments and subsequent actions for patients experiencing advancing sedation during opioid analgesia.