Administering opiates

Nurses General Nursing

Published

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.

Specializes in Cardiovascular recovery unit/ICU.

Absolutely right. There are receptors in the pain control section of the brain called "mu" receptors. Using dilauded as a first line takes up and binds to these receptor sites and tolerance builds. That's why so many addictionologists use bupenorphine or suboxone for their patients. It helps heal the mu receptors and lower the tolerance level to where the person can get relief from opiated if needed in the future, say from surgery.

Up Vote Up Vote ×

We are required to waste at the ADM when we pull the narcs. This must be witnessed by another RN. If your want to dilute in NS, you can do it with the other nurse there. It's all honor system regarding the actual delivery to the patient.

Up Vote Up Vote ×
Specializes in ICU.
I don't understand the thought process behind why one cannot dilute a medication with NS. For example if i Y site two compatible medications, isn't this technically diluting as well? for example if i have fentanyl running with NS, what is the difference between this and diluting the fentanyl IVP?

Chemistry. The make-up of the drugs.

Up Vote Up Vote ×
Specializes in ICU.
Some facilities to control narcotics, or there are LPN's that can't administer IVP meds, routinely will make up small bags.

In my state a LPN cannot administer narcotucs IVP.

Up Vote Up Vote ×
Specializes in ICU.
In some locations its taught and customary to dilute. The biggest advantage I can think of it that it allows the actual drug to be pushed closer to its safe administration rate. It's difficult to push 0.5ml over three minutes, for example.

There is a segment of the population that can become addicted to these drugs very quickly, although certainly not everybody.

They don't become addicted with a few IVP. They were already addicted to something before coming in if you feel they are becoming addicts after a few pushes. I guarantee it. One does not become addicted by taking pain meds exactly as prescribed. It's when they start taking "more" than what is prescribed. A few pushes in the icu does not make a person addicted, I'm sorry. Most of the people that get drips or pushes are so sick they are barely aware of what they are getting. If they are aware enough, they should be getting POs, which last longer and are more effective. Fentanyl is in and out of the blood stream quickly, which is why it is most often used as a drip, or used as a patch with cancer patients.

You are not making an addict from it. It's too short acting. It's why addicts put 12 patches on their tongues to OD. That so-called rush doesn't last at all.

At what point will we, as medical professionals, actually learn about pharmacology and addiction? Really? Right now, we are letting a bunch of non-medical legislators try and regulate meds. Knee-jerk reactions to meds is what is taking place, without anybody learning and understanding the problem. This leads to addicts not getting the treatment they need, and people in actual pain being denied meds that may make their quality of life better.

It is possible to push a med over 3 minutes. I do it all the time. It's an art, but can be done. But last I saw, Fentanyl and Dilaudid didn't need to be pushed like that.

Up Vote Up Vote ×
Specializes in Hospice / Psych / RNAC.

You aren't going to like what I say, but you are way to obsessed with the patient knowing their drugs are suppose to be original. Pushing IV opiates to give them a rush is beyond the pale. I would report you.

Up Vote Up Vote ×
Specializes in ER.
You aren't going to like what I say, but you are way to obsessed with the patient knowing their drugs are suppose to be original. Pushing IV opiates to give them a rush is beyond the pale. I would report you.

Hahaha, I got a good laugh, thanks! Beyond the pale??? Hehe! Report me? Too funny!

Up Vote Up Vote ×
They don't become addicted with a few IVP. They were already addicted to something before coming in if you feel they are becoming addicts after a few pushes. I guarantee it. One does not become addicted by taking pain meds exactly as prescribed. It's when they start taking "more" than what is prescribed. A few pushes in the icu does not make a person addicted, I'm sorry. Most of the people that get drips or pushes are so sick they are barely aware of what they are getting. If they are aware enough, they should be getting POs, which last longer and are more effective. Fentanyl is in and out of the blood stream quickly, which is why it is most often used as a drip, or used as a patch with cancer patients.

You are not making an addict from it. It's too short acting. It's why addicts put 12 patches on their tongues to OD. That so-called rush doesn't last at all.

At what point will we, as medical professionals, actually learn about pharmacology and addiction? Really? Right now, we are letting a bunch of non-medical legislators try and regulate meds. Knee-jerk reactions to meds is what is taking place, without anybody learning and understanding the problem. This leads to addicts not getting the treatment they need, and people in actual pain being denied meds that may make their quality of life better.

It is possible to push a med over 3 minutes. I do it all the time. It's an art, but can be done. But last I saw, Fentanyl and Dilaudid didn't need to be pushed like that.

These comments really surprise me. Do you talk to your "drug-seeking" patients? If you create a supportive environment, they will tell you their stories. A lot of them started out with a legitimate, painful medical issue and just kept coming back over and over with undiagnosible "pain" afterwards. And you don't have to take their word for it- just look at their hospitalization histories. I'm not in the ICU, so mine are definitely not so sick that they don't realize what they're getting (or how often or at what dose).

You absolutely can become addicted taking medication as ordered- even short term. Having an order verses not having an order doesn't turn an apple into an orange. I've had patients tell me about short-term hospital stays where they went home, got sick, and realized (after seeking medical care) that they were going through withdrawals. They didn't do anything wrong and it's not their fault ...and I certainly don't believe that people should be deprived of relief from pain, but we need to do a better job of tapering their doses down before we send them home (assuming they're not terminally or chronically ill). Some doctors are very good at it, but most are not.

And yes, it is possible to push any amount of any medication over any length of time. Some amounts and some times just work better together. I don't dilute anything because its not customary where I currently work. And although these drugs all have "push rates", I'm sure 99% of us push it faster than directed ...not intentionally, it's just not practical to spend three minutes on one IV push when there are loads of other tasks waiting to be done (and a slightly faster rate is very unlikely to harm the patient).

Up Vote Up Vote ×
I have accompanied my brother to his pain management appointments and they are always very quick for him, then my education with the doctor begins. I always advocate for pain management for my patient, but I also advocate if a provider uses Dilaudid front line. This PM M.D. has educated me that Dilaudid resets the pain receptors, not only does it increase tolerance, it actually heightens the pain response so initial pain level is higher than pre-Dilaudid. You screw up their pain management for life by giving it. I saw this first hand (how I got the info) when my wife had a high grade fracture that was treated with Dilaudid. Percocet used to be more than enough, now it doesn't touch her.

I am in nursing school and this is news to me! How long does a patient have to take it before this happens?

Up Vote Up Vote ×
+ Add a Comment