Did he get too much morphine?

[Deb123j]

I'm a new nurse and am still learning drug doses and such.

My brother had a lapchole today. After the surgery he was in his room resting comfortably. A student nurse comes in and asks if he's in any pain (syringe of pain medication in hand), he said a little only when he tries to urinate. She asks if he wants the pain med and he says sure. So in it goes.

A little later he's feeling light-headed and really sleepy. Student nurse comes in and I asked how much morphine she gave him...she gave 8mg. Isn't that a bit much for a pt who really isn't in much pain??? I would think that 2mg would have been much more appropriate. I'm assuming the doc wrote a range for the pain medication, like 2-8mg prn.

What do you all think???

[katie258]

This is interesting. In Australia you need to have two staff members present to give a schedule eight drug. We confirm the prescription, get it out of the cupboard, count how much is left and write it in the S8 book. Then the medication is drawn up, we both go to the bedside, check the right pt, no allergies etc then the drug is given. If the dose is smaller than the vial contains all is drawn then what isn't needed is discarded. You guys just hop around with pre filled syringes of morph in your pockets?

[Virgo_RN, BSN, RN]

This is interesting. In Australia you need to have two staff members present to give a schedule eight drug. We confirm the prescription, get it out of the cupboard, count how much is left and write it in the S8 book. Then the medication is drawn up, we both go to the bedside, check the right pt, no allergies etc then the drug is given. If the dose is smaller than the vial contains all is drawn then what isn't needed is discarded. You guys just hop around with pre filled syringes of morph in your pockets?

We use a Pyxis machine. You enter your user number and confirm your identity via fingerprint or password. You select the patient from a patient list, then the drug from the list of drugs. If you don't use the full amount of drug, you have to waste the remainder in front of a witness who also enters their user number and fingerprint/password.

The Pyxis keeps a record of all drugs removed by all users, and that record can be compared with the computerized MAR and any discrepancies noted.

As a student, I may give IVP medications, but only once my competence has been verified by both my CI and the RN I'm paired with. I am not allowed to get any medications out of the Pyxis. The RN or CI gets anything I need out of the Pyxis for me.

8mg of MS for a fresh post op is not unheard of. However, I would be asking the patient their pain score on the one to ten scale and medicating according to their reported pain level. 8mg of MS would be reserved for severe pain, up in the 8-10 range, and then, only if I was reasonably certain the patient could tolerate that amount.

I too, wonder what this student was thinking, and where the RN or CI were at this time? Did the RN give the student the med and tell them to see if the patient has any pain and administer the med if that was the case? Perhaps the RN overestimated the student's level of competence in this area. Or, perhaps the RN his-or-her self is inexperienced. There is really no way to know from an internet post what really happened.

[CountyRat]

"You guys just hop around with pre filled syringes of morph in your pockets?"

Noooo. Our procedures are very much like those you describe in Australian practice. That is what makes this anecdote so interesting. And, confusing.

[queenjean]

OMG, if I had to get a witness to give every narc I give, they would have to double staff our floor all night. Some nights every one of my pts in on some type of narc, sometimes multiple doses throughout the night. What a terrible hassle it would be to have double nursing for every single dose. Thank god for our pyxis!

As far as the student nurse--yeah, that was weird. I don't think that is too much morphine to give IV. I've given more than that before. I think, based on the OP's post, the pt probably didn't need that much. But I wasn't there to assess first hand. I dont' think the student should have just had the syringe in her pocket, though. I guess I've pulled morphine and then gone into the room when I've guessed the pt would want it (like, if they'd wanted it about every two hours, and it's been two hours or more and I'm going in to give other meds); but if they don't want it, I just return it for later use.

I dunno, I can see both sides of it. I think it is really difficult to tell second (or third, or fourth) hand what is going on in situations like this.

[steve0123]

Did he get too much morphine?

Intravenously - perhaps 8mg is a bit much to push in one go.

IM/SC - not at all.

[HardwrknRN]

I'm a new nurse and am still learning drug doses and such.

My brother had a lapchole today. After the surgery he was in his room resting comfortably. A student nurse comes in and asks if he's in any pain (syringe of pain medication in hand), he said a little only when he tries to urinate. She asks if he wants the pain med and he says sure. So in it goes.

A little later he's feeling light-headed and really sleepy. Student nurse comes in and I asked how much morphine she gave him...she gave 8mg. Isn't that a bit much for a pt who really isn't in much pain??? I would think that 2mg would have been much more appropriate. I'm assuming the doc wrote a range for the pain medication, like 2-8mg prn.

What do you all think???

While I do not know everything that went on in the room I do know that IL student RNs are not allowed to give medications without the instructor being present and witnessing the administration on the floor(for my state anyway, I know the rules may be different according to where you practice). I do think that 8 mg of morphine is a large dose for some, but for others this may be an appropriate dose amount. Many pt's have massive tolerance to narcotics, so they are noted to require more for pain relief than the majority of our patients. I am wondering if your brother normally needed the higher dosage for relief and that the nursing staff knew that giving him 2-4 mg IVP would not give him relief. Hopefully the RN assessed pain and explained to your brother that that due to his low K level he will need a K+ rider. Maybe the teaching occured prior to you getting there for the visit? Anyhoo, if your brother is competent/alert/oriented then the RN/student/staff is under no obligation nor are they permitted to explain his plan of care/diagnosis/treatment to visitors and or family without consent from the patient.

[rjrule]

I work in ED in southern NSW Australia, we tend to give Morphine for moderate to severe pain and only in 2.5 increments IV until the pt is out of pain. By the sounds of the pain that your brother was experiencing, he may have been OK with some oral meds (assuming he had tolerated diet post op). We use Panadeine Forte for mild to mod. pain. I cannot understand why a student was giving a s8 medication. No student can give any S8 (narcotic) in our hospital or country for that matter. We do not have pre filled syringes. Was the morphine given IV or Im? And yes, In oz down south in NSW we too have to check narcotics with another nurse . The narcotics register is audited every month and checked each shift by two nurses.