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Discussion

Administering opiates

I was just reading another thread of someone who got accused of diverting because of diluting morphine in a NS bag to administer.

It reminded me of my rules for handling/administering controlled substances.

1) I always unwrap packets in room, whether IV or PO. I want the pt to have NO QUESTION that I'm giving them the right med. I'll leave the wrappers on the counter until next time I make rounds in case they want to sneak a look.

2) I only do a slow IV push for opiate naive pts. For the seasoned user, a faster push gives them the little rush that assures them they are getting the drug they want/need. I do this to instill confidence in the pt that I'm not stealing their med.

3)I always waste immediately unless it's a dire emergency and time is totally of the essence. I'll still bring the empty original container to temporarily leave on the counter.

In short, I'm not here to change the world. If it's ordered, I give it. Controlled substances are treated by me as radioactive materials that can cause me damage.

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    • Featured Replies

    2) I only do a slow IV push for opiate naive pts. For the seasoned user, a faster push gives them the little rush that assures them they are getting the drug they want/need. I do this to instill confidence in the pt that I'm not stealing their med.

    That's a minor pet peeve of mine. I'm constantly having to explain to patients that they are not supposed to feel a rush ....and that if they have been feeling one, that means their medication has been being administered too quickly.

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    • Author
    That's a minor pet peeve of mine. I'm constantly having to explain to patients that they are not supposed to feel a rush ....and that if they have been feeling one, that means their medication has been being administered too quickly.

    I agree. But I've come to the conclusion that pt satisfaction is good for my career. And reading the nurses in recovery section here has been eye opening. People get falsely accused. I like to stay employed.

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    • Experts

    Which thread is the one you are talking about.

    It is always best to be careful with narcotics. Develop a routine and stick to it.

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    Where I work, we dilute all IV narcotics in minibags and give them as secondary meds. I've never pushed a narcotic or seen anyone do it in my entire career. Funny now practices differ!

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    Where I work, we dilute all IV narcotics in minibags and give them as secondary meds. I've never pushed a narcotic or seen anyone do it in my entire career. Funny now practices differ!

    That is amazing to me.

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    • Experts

    Yes we are the same. it's always diluted in a minibag and hung as a secondary. I've seen it pushed but very seldom.

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    I work on an ortho unit and we use a LOT of IV narcotics. We never mix in mini bags-pharmacy is the only one that can do that. I can dilute 0.5mg or 1 mg (our usual breakthrough dose) in a 10 mL flush syringe or push it through a running line. that way they don't get that "rush" I had a pt that was on 5:1 dilaudid with a generous 4 hour lockout and this pt STILL wanted the push.

    It's all about education. It kills me that some would rather have 0.5 mg of IV meds over 6 mg of PO. SMH.

    We give scheduled tylenol and try very hard to keep prn meds as close to scheduled as possible to avoid pain getting away from the pt. Of course there are the ones that just want as much medication as they can get. What really drives me nuts are the nurses that don't follow the orders of giving the PO meds first THEN the IV. Path of least resistance, but having to work a shift after a nurse like that makes me the meanie.

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    In the ICU setting, many times it is IVP for narcs. Diluting would take too long.

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    • Experts

    We mix our own narcs in minibags all the time.

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    • Admin
    Where I work, we dilute all IV narcotics in minibags and give them as secondary meds. I've never pushed a narcotic or seen anyone do it in my entire career. Funny now practices differ!

    Yes we are the same. it's always diluted in a minibag and hung as a secondary. I've seen it pushed but very seldom.

    Perhaps it's a different norm in Canada, since that is where you both are from? The only time I've seen narcotics in minibags is when it's used for long-term sedation in a vent-dependent patient. Pain relief? IV push is the only method I've seen.

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    • Experts

    We use it for pain relief. For me it's mostly post op if they have no PCA.

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