how do you give morphine on a pump bedside?

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?

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.

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.

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.

Edited Nov 18, 2009 by heartrn716
Grammar

[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.

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.

[OldnurseRN]

After many years as an oncology/hospice nurse we ALWAYS had patients on morphine drips running on infusion pumps. No way would a PCA provide the dosages these patients required. We mixed our own drips. If the patient was requiring higher doses we would mix a 2:1 ratio. It was not unusual for patients getting as much as 125mg/hour or more! Once you get ahead of the pain the dose is weaned down. It's not financially feasible to use a 60 ml PCA syringe on these patients.

[chenoaspirit, ASN, RN]

If our patients required larger doses such as oldnurse stated, our pharmacy would mix us up larger bags or syringes for our PCA pumps to last longer. No way would I work on a floor with visitors with an unlocked bag of narcotic hanging. That wouldnt work at all in our community. We even caught a visitor cutting the tubing on a PCA line and trying to drain the morphine out into a med cup. Imagine if this visitor had access to a bag hanging freely on a IV pole Nope, no way. We always used PCA pumps and programmed a continuous basal rate if patient was unable to press the bolus button.

1) In an ICU where you can get in the room more often, I'd be fine on a pump, but on a floor, I'd want a PCA (on basal) so I could lock it and have more "control" of the narcs.

2) If you are using a regular pump, and you're running out too soon, are you accounting for the amount required to prime the tubing? While it's "nothing" when you're thinking about fluids or even antibiotics, it's a lot if you're counting narcotics.:)

When we have patients on morphine drips we put the bag of morphine in a locked plastic box and hang the box on the IV pump. And our IV pumps have a lockout code that needs punched in before the pump is able to be used. Only the nurses have the code and the keys so the family is unable to change the rate. We also have the ability to use continuous PCA pumps, but i've rarely seen that.

In our hospital they mix 250 mg morphine in 250 mg normal saline for our pallative care patients which is placed on a regular pump. My concern is that the IV bag itself is unlocked and anyone could access it. I noticed that some listed or showed plastic lock boxes, can I get some information on these to share with my hospital?