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Risks of post-operative respiratory depression ocurring in obese patients who may or may not have pre-morbid history and who are receiving opioid analgesia (February 2014)

In a finding of 14 February 2014 the Deputy State Coroner made the following recommendations

  1. That the Minister for Health, the Australian Commission on Safety and Quality in Health Care and the Australian Council on Healthcare Standards, consider as a requirement of accreditation that small private hospitals like Sportsmed which have no on-site medical practitioners overnight, and no ICU backup, develop robust pre-admission processes in which higher risk patients are screened to ensure that they are not accepted for overnight admission unless they have been assessed as suitable for that facility by a medical specialist or anaesthetist, well in advance of the planned admission date;
  2. That the Medical Board of Australia, the Australian Medical Association, the Australian Medical Council, the Australian College of Nursing and Australian Nursing Schools attempt to raise awareness amongst medical practitioners and nurses about the inherent risks of post operative respiratory depression occurring in obese patients in particular, who may or may not have a diagnosis of sleep apnoea and who are receiving, or have received, opioid analgesia;
  3. That the Medical Board of Australia consider formulating a code of conduct which stipulates that medical practitioners who practise preferentially in a facility in which they have a financial interest, should disclose that fact to the patient appropriately and specifically raise the issue concerning suitability of that facility with other specialists to whom they refer the patient for pre-admission assessment;
  4. That the Australian and New Zealand College of Anaesthetists (South Australian branch) consider reaching an understanding with the Royal Australasian College of Surgeons (South Australian branch) and the Australian Society of Orthopaedic Surgeons to streamline the process by which higher risk patients are referred for pre anaesthetic assessment and to avoid last minute changes to operating lists where this would result in a different anaesthetist taking over immediately before surgery;
  5. In the interests of patient safety, that Board Members and Chief Executive Officers of hospitals with staff and facilities similar to, or less than those at Sportsmed, consider implementing policies whereby those hospitals decline to admit higher risk patients to their facilities.

The finding in full can be found on the Coroner's website website at this link.