Intravenous HYDROmorphone: Can You Manage the Risk?

• 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
• ISSN: 0099-1767; 1527-2966
• DOI: 10.1016/j.jen.2011.03.010

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.