IM dilaudid

  1. In our ED, we have a flowsheet for pts who are given dilaudid, we must monitor vitals Q15 minutes until pt is stable. I have completed these sheets on IV and IM admin routes, but I worked a night shift today and my charge nurse was giving IM dilaudid and discharging pts ASAP. I felt this was a little unsafe, all pts had a ride home but we usually monitor at least 30-45 minutes to see if any adverse reactions. Thoughts?
  2. Visit thelema13 profile page

    About thelema13

    Joined: Jun '11; Posts: 287; Likes: 374
    Specialty: 3 year(s) of experience in ED


  3. by   roma4204
    Like walking out the door right away after or discharging then waiting to leave after?
  4. by   Sanuk
    If we had to monitor pts like that after dilaudid, I would spend my whole shift doing VS. We give out dilaudid like candy. Our policy is 20 minutes, one set of VS, and they can go - IV or IM.
  5. by   apocatastasis
    Yeah, I find that VS policy pretty ridiculous. How do you determine "stable?" I don't think I have ever had a patient become "unstable" from 1mg IM dilaudid. To be on the safe side, I make sure they have a pulse ox on them and blood pressure cuff to monitor from the nurse's station, but I try to do that with most patients anyway.

    Our ED's policy is to hold 30 minutes after any injection, instituted I believe mainly as a result to ensure no allergic reaction to parenteral antibiotics. We very rarely give IM narcotics just prior to discharge. There are many variables involved in pharmacokinetics, and I can't see that holding for 30 minutes would be sufficient for all patients.
  6. by   Anna Flaxis
    We monitor for 20-30 minutes, reassess pain and VS, with no separate flow sheet.
  7. by   GM2RN
    We monitor for 15-20 minutes if that is the first shot they have gotten and are to be d/c'd after, but not necessarily for pts who have been in the ED for awhile and have been getting dilaudid, morphine, or whatever all along. And no special flow sheet here either...just chart results normally.
  8. by   applewhitern
    We give so much dilaudid, we joke that there is a billboard on the interstate that says "Dialudid~this way!." I always keep them at least 20 min.
  9. by   thelema13
    Stable as in RR, O2 and LOC. I have not seen much adverse reactions to IM, but a few have passed out right after admin of IV.

    Flowsheet is completed just to monitor VS, usually dont have to do vitals more than x2.
  10. by   Murse901
    We hold for 30 minutes after injection (IM or IV), keep them on the pulse-ox (which is centrally monitored), and d/c them only with a driver.

    If we had to do VS q15 minutes on everyone we gave Dilaudid to, we'd be doing nothing but VS all day.