IM dilaudid

  1. 0
    In our ED, we have a flowsheet for pts who are given dilaudid, we must monitor vitals Q15 minutes until pt is stable. I have completed these sheets on IV and IM admin routes, but I worked a night shift today and my charge nurse was giving IM dilaudid and discharging pts ASAP. I felt this was a little unsafe, all pts had a ride home but we usually monitor at least 30-45 minutes to see if any adverse reactions. Thoughts?

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  2. 8 Comments...

  3. 0
    Like walking out the door right away after or discharging then waiting to leave after?
  4. 2
    If we had to monitor pts like that after dilaudid, I would spend my whole shift doing VS. We give out dilaudid like candy. Our policy is 20 minutes, one set of VS, and they can go - IV or IM.
    GM2RN and DeLanaHarvickWannabe like this.
  5. 0
    Yeah, I find that VS policy pretty ridiculous. How do you determine "stable?" I don't think I have ever had a patient become "unstable" from 1mg IM dilaudid. To be on the safe side, I make sure they have a pulse ox on them and blood pressure cuff to monitor from the nurse's station, but I try to do that with most patients anyway.

    Our ED's policy is to hold 30 minutes after any injection, instituted I believe mainly as a result to ensure no allergic reaction to parenteral antibiotics. We very rarely give IM narcotics just prior to discharge. There are many variables involved in pharmacokinetics, and I can't see that holding for 30 minutes would be sufficient for all patients.
  6. 0
    We monitor for 20-30 minutes, reassess pain and VS, with no separate flow sheet.
  7. 0
    We monitor for 15-20 minutes if that is the first shot they have gotten and are to be d/c'd after, but not necessarily for pts who have been in the ED for awhile and have been getting dilaudid, morphine, or whatever all along. And no special flow sheet here either...just chart results normally.
  8. 1
    We give so much dilaudid, we joke that there is a billboard on the interstate that says "Dialudid~this way!." I always keep them at least 20 min.
    TriathlonRN likes this.
  9. 0
    Stable as in RR, O2 and LOC. I have not seen much adverse reactions to IM, but a few have passed out right after admin of IV.

    Flowsheet is completed just to monitor VS, usually dont have to do vitals more than x2.
  10. 0
    We hold for 30 minutes after injection (IM or IV), keep them on the pulse-ox (which is centrally monitored), and d/c them only with a driver.

    If we had to do VS q15 minutes on everyone we gave Dilaudid to, we'd be doing nothing but VS all day.

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