Morphine dose in vial?

[Chaya, ASN, RN]

So at both of the places I have worked (Med-Surg settings) the most common dose prescribed for IV morphine is 2 mg. However, it is dispensed in 5 mg vials. This means we need to do a witnessed waste for 80-90% of the patients who receive morphine each time and they could get multiple doses each shift. Apparently this has something to do with packaging and it is not as easy as just ordering 2 mg dose vials or whatever.

So my question is; does this happen where you all work? Are higher doses more common in other practice area or is it common experience in most settings to routinely be wasting over 50% of each dose? (Not only wasteful but high potential for diversion/ abuse as well.) Or are you giving 2 mg routinely and able to obtain a lower dose vial or dispensing system?

Thanks,

Chaya

[SNIXRN]

We have 2mg vials at my work.

[imintrouble, BSN, RN]

We have 2, 4, 10mg vials. I agree with the problem of wasting and diversion.

I guess nobody asked the nurses when stocking the pyxis.

[Pepper The Cat, BSN, RN]

WE have 10mg vials. Occasionally we will get 2mg but not often.

[Biffbradford]

They also make pre-filled syringes with 2, 4, and 10mg.

[Amnesiac70]

Ask your pharmacy for smaller vials. That would be a huge waste of time trying to find a witness for 80-90% of my morphine pulls.

[cubangirl]

We always have 2 and 4 mg. Never higher than that

[ChristineN, BSN, RN]

We have 2mg and 4mg vials and I want to say 1mg as well. Having 5mg vials only would be annoying

[Reno1978, BSN, RN]

We have 2mg, 4mg and 10mg carpuject syringes.

[psu_213, BSN, RN]

A little while ago, there was supposedly a "national shortage" of 1mg carpujets of Dilaudid--on 2mg carpujets were available. Most of our pt's only get 0.5mg or 1mg of Dilaudid, especially in their first dose. Needless to say, we had to do a lot of witnessed wastes and threw out quite a bit of narcotics. Thankfully, the 1 mg is back.

For morphine we have 2mg and 4 mg carpujets and 10mg vials.

I'm really not sure of a high potential for abuse with wastes. There is a high potential for accidentally taking home half an unwasted vial.

[loriangel14, RN]

We have 2 and 10 mg vials where I work. Most of our orders are 2-10mg or 2-20mg. These are usually our palliative patients. Quite often if they are getting quite a bit of morphine we use pain pumps so frequent draws aren't an issue.

[umcRN, BSN, RN]

we have 2mg vials, however I work in a nicu and we give morphine based on a range which is 0.05mg/kg up to 0.2mg/kg, which makes a VERY small dose for most of our patients, and yes, even if they are getting it around the clock we must pull a new vial for each dose and have a witnessed disposal of the waste.