how do you give morphine on a pump bedside?

[ivy2009]

The real question is in our hospital we have PCA pumps for post-ops to press. On my floor --one third of our patients are cancer patients --they are on either a morphine drip or dilaudid drip on a pump --it is not locked on the pump --its just a regular IV pump.--we are noticing at the end of the 100cc bag is running out too soon for the rate it is running--so?? they are wondering if someone is taking some of the medication out of the bag. Family could, employees ..... what do you nurses have in your hospitals for pumps that could prevent this possible crime.

[Tait, MSN, RN]

We use locked PCA pumps with 55ml syringes and locked Epidural containers with 250ml bags. Both require keys and codes and are formed of solid plastic.

Tait

These are the exact ones we use.

[roser13, ASN, RN]

I'm confused. Your first sentence says your hospital has PCA pumps, but on your floor it's only a drip for morphine and dilaudid?

Why are you not using PCA's for narcotics?

[ivy2009]

We only use PCA pumps for conscious patients who are able to press the button--our cancer patients are mostly inhouse hospice on a continual pain drip--unable to press for relief.

[itybits]

Our PCA pumps also have the capability to provide a continous basal rate-just like a drip.

[Tait, MSN, RN]

Our PCA pumps also have the capability to provide a continous basal rate-just like a drip.

Likewise.

[MedSurgeMess]

We only use PCA pumps for conscious patients who are able to press the button--our cancer patients are mostly inhouse hospice on a continual pain drip--unable to press for relief.

Most, if not all, PCA pumps can be programmed to deliver continuous flow at a rate the MD determines. This would be so much safer and possibly more cost effective than what your facility is doing.

[heartrn716]

Our PCA pump also allows a basal/continuous rate. I agree, continuous morphine, dilaudid or ativan that is not on a locked pump is too much of a temptation for some licensed staff and you never know what the visitors are capable of.

Investigate what the literature suggests.

[Lacie, BSN, RN]

It's not only tempatation its a safety issue more than anything. I know myself I would not be comfortable setting narcotics such as these on a regular pump. I have had confused pts change settings, family members try to silence alarms, etc. I've always worked primarily in critical care units and all our narcotics per drips were always on PCA with a continous drip setting. Do they not have enough PCA pumps or not willing to obtain them? Again it's more of a safety issue for me.

[tewdles, RN]

The practice you describe is not standard for palliative or hospice care. Those opioid infusions need to be on controlled, locked pumps. There should be no question, in your environment, about the pedigree of those medications...pharmacy, RN, pump/pt.

[roser13, ASN, RN]

I agree with the above posts. Morphine/Dilaudid drips without a controlled syringe (PCA) would not be sanctioned in any facility in which I have ever worked.

[questionsforall]

In our ICU we have morphine drips on a regular pump, we do account 15 ml for priming of the tubing, so a 100 ml bag with new tubing would count as 85 ml. (bags hung after that are counted as 100 ml). Once we send the patients to the floor we have to send them with a PCA pump.