Intravenous HYDROmorphone: Can You Manage the Risk?

In a prospective, randomized, double-blind, clinical trial of 198 adult patients presenting in acute severe pain to an academic medical center, Chang and his team observed significant reluctance from emergency department prescribers and nurses when they were asked to use 7 to 10 mg of morphine as an...

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Bibliographic Details
Published in:Journal of emergency nursing 2011-07, Vol.37 (4), p.377-380
Main Author: Paparella, Susan
Format: Article
Language:English
Subjects:
Acute Pain - drug therapy
Adult
Analgesics
Analgesics, Opioid - poisoning
Analgesics, Opioid - therapeutic use
Anesthesia
Drug dosages
Drug Overdose
Emergency Nursing - methods
Fatal Outcome
Health facilities
Heart Arrest - chemically induced
Hospitals
Humans
Hydromorphone
Hydromorphone - poisoning
Hydromorphone - therapeutic use
Injections, Intravenous
Male
Medication Errors - prevention & control
Nursing
Pain management
Patients
Respiratory Insufficiency - chemically induced
Risk management
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Summary:In a prospective, randomized, double-blind, clinical trial of 198 adult patients presenting in acute severe pain to an academic medical center, Chang and his team observed significant reluctance from emergency department prescribers and nurses when they were asked to use 7 to 10 mg of morphine as an initial starting dose to treat pain; however, the same health care providers showed no hesitancy when a 1- to 1.5-mg dose of HYDROmorphone was suggested. In another ED study, Chang and colleagues showed that following a 2-mg intravenous dose of HYDROmorphone, clinically significant oxygen desaturation developed in up to one third of adult non-elderly patients in the emergency department who complained of severe acute pain.9 Based on advice from its clinical experts, one drug information resource, Lexi-Comp, revised its drug information for HYDROmorphone in 2002 to suggest that an appropriate starting dose of HYDROmorphone for opioid-naïve patients is 0.2 to 0.6 mg administered intravenously every 2 to 3 hours as needed.\n Based on your findings, mitigate the potential for harm by limiting the strength and volumes of HYDROmorphone available in the emergency department to only those doses that are necessary.
ISSN:0099-1767
1527-2966
DOI:10.1016/j.jen.2011.03.010