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.
Taking up an ICU bed seems like a waste..I know in my inner city hospital the ICU nurses have much more critical patients to care for. If the patient is low maintenance post-op and can go right to the floor(not a neurosurgery case for instance in which case they would go to the NSICU) if they could only tolerate fentanyl that shouldn't pose any problems at all. Actually in my hospital if a PCA is needed(and we use them quite frequently) Fentanyl and Diaudid are the narcs of choice. In the PACU immediately post op IV fentanyl is used as often as dilaudid and morphine are.
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