[NRSKarenRN]

From March 2007 issue of Nurse Advise-ERR®

Error in drug references.

Incorrect dosing information for

DILAUDID

(hydromorphone) appears

in several drug references, which
could lead to serious overdoses.
Monographs on page 815 in the
2006 Nurse's Drug Guide (Pearson-
Prentice Hall) and page 138 in the
2006 Nurse's POCKET Drug Guide
(McGraw-Hill Medical, 2nd edition)
erroneously indicate that the dose
ranges for hydromorphone are the
same for oral, subcutaneous, IM, and
IV routes of administration. The same
errors occur in the 2007 editions
of these texts. The usual oral dose in
opioid-naïve patients is 2-4 mg every
3 or 6 hours prn; parenteral doses are
typically one-fifth of oral doses, or
0.2 to 0.6 mg every 2 to 3 hours. The
error was discovered by a resident
after nurses questioned the doses of
hydromorphone he had been prescribing
using the above texts.
Fortunately, no patients received the
incorrect dose prescribed. The publishers
for each handbook have been
notified and have forwarded the information
to the appropriate editors for
correction in the 2008 editions. If you
use either of these references, please
correct the error directly in the publication
and be sure to verify doses before
administration.

Visit www.ismp.org/Errata/default.asp for other reports of
textbook errors.
www.ismp.org/Newsletters/nursing/Issues/NurseAdviseERR200703.pdf

[meandragonbrett]

Thanks for the heads up! We routinely give 1-2mg Dilaudid IV. Knocks people off their feet too.

[sshannon]

Thanks for this post. My nursing class is using the 2006 edition of the Nurse's Drug Guide. I passed the info along to my clinical instructor so she can forward to others.

[meandragonbrett]

I wonder why nobody else knows this? I am even seeing orders now for 2-3mg q2h prn