Morphine dose in vial?

[Chaya]

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?

Thanks,

Chaya

[sonja77]

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)

Our morphine carpuject syringes are manufactured by Hospira.

http://products.hospira.com/search/productDetails?listNumber=MORPHINE_SULFATE_02&category=Drugs&page=Drugs&sort=ndc&order=asc

[Penelope_Pitstop, BSN, RN]

We have 2mg, 4mg and 10 mg available for Morphine.

For Dilaudid, we have 1 mg and 4 mg.

And, the one that annoys me, Ativan is ONLY in 2 mg.

[JBudd, MSN]

We have 2 and 10 mg carpujects. We used to have the 2mg Dilaudid carpuject, but the pharm tech loaded Dilaudids in the Morphine drawer, and 3 patients got the wrong stuff (what happened to reading the dang label three times!!!?). 3 different nurses, arghh!! Took me a while to chase it all down and do the incident reports.

Considered a sentinel event, and we now only have 1 mg Dilaudids to get rid of the look-alike problem.

When my late dh had CA, I had the 15mg/ml Morphine vials at home.

I've been told the packaging is what is expensive, not the volume of drug; so they may buy the larger dose to save money. After all, having to pull 2 vials for a 2 mg dose costs more, and who cares if it takes up nurses' time to have to waste all the time.

[psu_213, BSN, RN]

And, the one that annoys me, Ativan is ONLY in 2 mg.

We have an MD who does not believe flexeril (sp?) is effective so he almost always uses valium and a muscle relaxant. When he orders it IV, it is usually 4 mg. Our IV valium comes as 10mg/2mL. Another waste...plus the importance of being able to do basic med math.

[talaxandra]

Wow, the things I never realised would be different! We stock morphine in 10mg, 30mg and 120mg ampoules; I was always taught that standard dosing (ie acute pain in opiate-naïve patients) was 1mg/10kg (or roughly 22lb), which fits with our usual dosing of 2.5mg to 10mg as an IV push or SC/IM injection.

Though the larger ampoules are mostly used for infusions (we prep on the wards and don't have 24/24 pharmacists), I've had at least one chronic pain patient who was having 30mg 4/24 IM.

From a waste POV - morphine's not very expensive, and most of the associated cost is the packaging and regulatory oversight (ie making sure none of it goes missing in the manufacturing process).

[loriangel14, RN]

A bit off topic but does anyone see much use of PCA ( patient controlled analgesic) pumps in chronic pain patients? Many of the patients that I care for have a PCA ordered if they are getting frequent PRN morphine (usually palliative or fresh post op patients).