Hospice pt in alf/morphine

Specialties Hospice

Published

Hi all,

I am an lpn working in an alf. We have a memory care unit and one of our ladies is on hospice.

A few weeks ago this pt was receiving liquid morphine prn.

Not sure what exactly happened but one of the nurses ended up getting fired bc the pt was "od'd on morphine" and supposedly there were 2 mL missing from the bottle.

For a few days the pt didn't get oob, wouldn't eat, lethargic, very low bp/pulse.

Only she bounced back a few days later. She is very up and down. Today she was sitting up talking like she normally is.

Have any of you experienced a "morphine od"

What are symptoms like?

Any words of advice w hospice would be appreciated. We have had a few hospice pts and i am still learning.

Thanks!!

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I have no idea how much was given in what time period. I have never had a "morphine OD" simply because 2mLs of Roxanol wouldn't do much more than put even an opioid-naïve person to sleep. And were I dosing someone at high levels that would be what we want.

I'm sorry someone was fired for giving comfort meds as ordered. Makes our lives a lot more difficult.

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2mL does not say much without knowing the concentration. The Roxanol we use is a 20:1.

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Specializes in hospice.

I'm sorry someone was fired for giving comfort meds as ordered. Makes our lives a lot more difficult.

But were they given "as ordered?" PRN means as needed, but one night while I was sitting with a patient for an 11th hour assignment in an ALF, I watched a med aide come in every hour on the dot and squirt morphine in the patient's mouth. I may only be a CNA, but my dispatch notes do include some med information, and the patient's morphine was every hour PRN. This guy was not having SOB and was not showing nonverbal signs of pain. He was relaxed and quiet. Yet, she gave that morphine every single hour.

Now I realize a med aide is not a nurse, but the same potential exists for misuse of a PRN order. And if that patient became responsive again after the morphine wore off, then that may be what happened. Or, it could be one of those ups and downs that hospice patients do sometimes, and completely unrelated.

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2 ml of roxanol is 40 mg which could kill an opiate naive person

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