So at both of the places I have worked (Med-Surg settings) the most common dose prescribed for IV morphine is 2 mg. However, it is dispensed in 5 mg vials. This means we need to do a witnessed waste for 80-90% of the patients who receive morphine each time and they could get multiple doses each shift. Apparently this has something to do with packaging and it is not as easy as just ordering 2 mg dose vials or whatever.
So my question is; does this happen where you all work? Are higher doses more common in other practice area or is it common experience in most settings to routinely be wasting over 50% of each dose? (Not only wasteful but high potential for diversion/ abuse as well.) Or are you giving 2 mg routinely and able to obtain a lower dose vial or dispensing system?
Specializes in psych, addictions, hospice, education.
Where I've worked, we'd use what we needed and save the rest for another dose for the same person. Then at the end of the shift we'd do the witnessed wasting of whatever was left. There was big potential for taking some home in the pocket though. I can't remember how we worked the pyxis so it worked out ok. One hospital didn't have a pyxis so that was no problem.
2, 4 and 10mg here too. We have run out of morphine and had to use 2mg of 10mg carpujet. Usually though we give 2mg or 4mg. Easy to do than always wasting.
i gotta say those vials all cost about the same, so while it's offensive to those of us who believe "a scout is thrifty," the actual money isn't much of a problem.
your pharmacy may consider looking at the actual medical plans of care for 2mg doses, and if that's a lot of what they see, perhaps they'll order boxes of the 2mg doses for use. this would also remove a potential temptation to someone who would prefer to pocket those 3mg leftovers. yes, even with "witnesses," a talented drug diverter can find a way to do that.
Specializes in Spinal Cord injuries, Emergency+EMS.
are leftpondians drastically more sensitive to Morphine or something ... 2 mg even IV may as well be homeopathic ... most places i've worked the standard regime is 10mg im/sc or 10 mg oramorph or for iv 1-10mg titrated to effect ..
Thank you all for the feedback. I couldn't believe that no-one makes a 2 mg dose if there is as high a demand for it as I thought there was. According to our pharmacy (and the one at my last job also) it doesn't seem to be available to us. I don't know if that is a regional supplier thing or what the problem is (we are located in the Metro Boston area). Our pharmacists say we could get syringes but the Pyxis wouldn't hold as many doses. (Are carpujets those syringe-type cartridges that you need to have a plastic piston type device to use with it?)
As for taking vials, etc home- we used to be able to draw up the dose and discard the vial in the sharps container in the med room with our witness but now we have to scan the actual vial at the patient's bedside. I've removed any number of alcohol wipes and "refused" colace caps from my washer/ dryer but have managed to catch myself before leaving with anything worse!
Anyway I don't know if we are allowed under AN terms of use to mention manufacturer's by name but if anyone is comfortable doing so I would like to pass them along to our pharmacy. You could PM me (or tell me the name of hospitals where you have used the prepackaged 2 mg dose and I can have our pharmacy contact theirs)
Whispera, MSN, RN
3,458 Posts
Where I've worked, we'd use what we needed and save the rest for another dose for the same person. Then at the end of the shift we'd do the witnessed wasting of whatever was left. There was big potential for taking some home in the pocket though. I can't remember how we worked the pyxis so it worked out ok. One hospital didn't have a pyxis so that was no problem.