How to give opioids and monitor sedation
Other platforms explain it with text and video. In VMS you practice it on the patient.
Opioids relieve severe pain but can slow breathing. Rising drowsiness almost always comes before breathing slows, so checking sedation is the earliest warning.
What you need
- Pain scale
- Sedation scale
- Pulse oximeter and, if available, capnography
- Naloxone
Step by step
Assess before the dose
Check pain score, respiratory rate and depth, oxygen saturation and sedation level. Note whether the patient is new to opioids. [1]
Look for added risk
Older age, sleep apnea, lung disease, kidney problems and other sedating drugs such as benzodiazepines raise the danger. [1]
Give the right dose and route
Check the order, the dose range and the last dose time. Opioids are high-alert, so follow your double-check policy. [1]
Reassess at the peak
Check sedation and breathing about 15 to 30 minutes after IV doses and 30 to 60 minutes after oral doses. [1]
Act on rising sedation
If the patient falls asleep during conversation, hold further opioid and call the prescriber. Oxygen saturation can look normal on oxygen even when breathing is slow. [1]
Treat respiratory depression
If the patient is hard to rouse or breathing is very slow, stimulate them, support the airway and give naloxone per protocol in small doses until breathing improves. [1]
Document
Record pain, sedation level, respiratory rate and saturation before and after each dose. [2]
Common errors
- Relying on oxygen saturation alone in a patient on oxygen.
- Giving the next dose to a patient who is drifting off mid-sentence.
- Giving naloxone all at once, causing severe pain and withdrawal.
Pasero Opioid-Induced Sedation Scale (POSS) [1]
| Level | What you see | Action |
|---|---|---|
| S | Normal sleep, easy to wake | Acceptable, no change |
| 1 | Awake and alert | Acceptable, no change |
| 2 | Slightly drowsy, easily roused | Acceptable, keep monitoring |
| 3 | Often drowsy, drifts off during conversation | Unacceptable: hold opioid, call the prescriber, monitor closely |
| 4 | Very drowsy, little or no response | Unacceptable: stop opioid, support breathing, give naloxone per protocol |
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
- Open RN, Nursing Pharmacology 2e (CC BY 4.0)
- Open RN, Nursing Skills 2e (Chippewa Valley Technical College) (CC BY 4.0)
Steps adapted from Open RN, Nursing Pharmacology 2e and Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. VMS is not affiliated with these organizations. Updated: 2026-10-11.