If a patient has a witnessed and documented allergy to morphine and dilaudid, is it reasonable to admit them to the ICU following major surgery so they can get fent? Or is that unheard of?
I don't know that it's unheard of, but not really necessary without other complicating factors. While fentanyl isn't used much on the floor where I am, we do occasionally have orders for Fentanyl IVP & even PCAs.
Reasonable to prescribe fent yes -- admit to the ICU no. That seems like a behemoth waste of resources, not to mention a burden to the pt who will be stuck with the bill. If the MD would be Rx'ing morphine or dilaudid on the floor, why not Rx an equivalent dose of fentanyl and admit to the floor?
There's not really any good reason why fentanyl has to be limited to use in the ICU. I know there are places where there is hesitation to use it on the floors, but I think it's just due to lack of familiarity. Fentanyl is actual an ideal opiate for those with renal issues or whose BP doesn't tolerate other opiates well. Where I work now, it's the only option for PCA's, which makes more sense than using something with a 3 hour half life.
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