Morphine Protocol

[caliotter3]

Could somebody please give me an idea what a hospice morphine protocol is? I saw this instruction with a hospice patient recently and did not get a chance to have my question answered by the case manager.

[tewdles, RN]

I am not sure what this protocol is...we don't use that language in my neck of the woods. It does make me wonder if they have the patient's pain plan written out.

I worked for a hospice which had a written leaflet for patient's and families about use of morphine for dyspnea and pain.

Perhaps they were conducting some research with a form or delivery method of morphine and that patient was a part of the group?

I just don't know...

[caliotter3]

The doctor had written a standard order for the use of morphine for pain and dyspnea and had included as the last sentence, "Use morphine protocol". Apparently the hospice has a policy/procedure in place for using morphine. I believe that they should have provided a written copy of that protocol for the use of the nurses providing the care. since we were assigned from another agency and were not hospice nurses.

[tewdles, RN]

You are absolutely correct caliotter3...if there is a written protocol available it should be physically provided to each and every nurse providing the care...especially agency staff. Sounds sort of reckless on the part of management not to.

[AtlantaRN, RN]

in the home, morphine sulfate 20mg/ml 5-20mg sl/po q1-2 hours prn breakthrough pain or dyspnea.......at least that is how we do it in the field......................

[Hospice Nurse LPN, BSN, RN]

in the home, morphine sulfate 20mg/ml 5-20mg sl/po q1-2 hours prn breakthrough pain or dyspnea.......at least that is how we do it in the field......................

That's our order, also for home pts. But, I know I wouldn't give Roxanol to anyone without a proper order. In the facilities, it can't be 5-20mg. We were told that that order would be nsg judgemnet and can't be used in a facility. It would have to be something like:

Roxanol 20 mg/ml give 5mg Q 2 hrs PRN pain/dyspnea.

[caliotter3]

You are absolutely correct caliotter3...if there is a written protocol available it should be physically provided to each and every nurse providing the care...especially agency staff. Sounds sort of reckless on the part of management not to.

I believe when the order was written the doctor had no idea that non-hospice nurses would be staffing the case, and common sense would have been that the protocol or any other questionable situations would have been addressed by the hospice supervisors.

[AtlantaRN, RN]

usually if the patient is in end stage-we order the roxanol on admission the 5-20mg sl q2h prn breakthrough pain or dyspnea..... Better to have it and not need it, than to need it and not have it. You are correct, ranges are not ordered in the nursing home setting.

linda