Oramorph: only one signature (TRIAL)

Jolie, BSN · Oct 15, 2005

Hi all:)
Just wanted your opinion!!!
We have just started trials on our unit, were, if a pt requires oramorph, only 1 RN signature is required to dispense and you don't need 2 to administer etc only 1.
The rational given,for the trial is pt in pain waiting to long for pain meds???
The unit is a busy 24 bed surgical unit, at first (still am)was doubtful if it was for Pt's benefit as the management are now staffing the unit with 1 RN and 1 HCA at weekends on nights:angryfire. Still believe staff shortages and cutting costs of bank or agency nurses has a part to play in this decision.
Also the only 2 units were the trial is occurring have both had their staffing levels cut at weekends???
Am concerned that if this is successful what next, are all controlled drugs going to be 1 Rn's signature????
Maybe im just a skeptic:uhoh3:
What do you think!!

gale

Please forgive my stupid questions, as I am a NICU nurse who has been out of practice for awhile.

Is oramorph an oral drug that is available in a unit dose form? If so, why would 2 signatures be required?

I have never known of a narcotic to require 2 signatures unless a portion was being wasted.

donmurray · Oct 15, 2005

I googled around, and can't find anything definitive. The NMC regs don't mention a need for a practitioner's signature to be witnessed;

http://www.nmc-uk.org/(ysuupzrd5od4ige5op34yjrq)/aFrameDisplay.aspx?DocumentID=221

It has been custom and practice for years, though. See if a union rep can advise. Good luck.

Silverdragon102, BSN · Oct 16, 2005

Please forgive my stupid questions, as I am a NICU nurse who has been out of practice for awhile.
Is oramorph an oral drug that is available in a unit dose form? If so, why would 2 signatures be required?
I have never known of a narcotic to require 2 signatures unless a portion was being wasted.

oromorph is a Opioid analgesics and in the UK comes under Preparations which are subject to the prescription requirements of the Misuse of Drugs Regulations 2001,

Opioid use in hospital means that 2 signatures are required to dispence from ward stock from a locked cuboard within a locked cuboard. Medication in the UK if required as a stock is issued to a set stock number depending on ward and demand. It is not dispensed on patient named basis. We do not have the facilities to have everything done like the US on patient basis plus the pharmacy usually out of hours has only 1 pharmasist on call and they only come in if they really have to.

Silverdragon102, BSN · Oct 16, 2005

Hi all:)
Just wanted your opinion!!!
We have just started trials on our unit, were, if a pt requires oramorph, only 1 RN signature is required to dispense and you don't need 2 to administer etc only 1.
The rational given,for the trial is pt in pain waiting to long for pain meds???
The unit is a busy 24 bed surgical unit, at first (still am)was doubtful if it was for Pt's benefit as the management are now staffing the unit with 1 RN and 1 HCA at weekends on nights:angryfire. Still believe staff shortages and cutting costs of bank or agency nurses has a part to play in this decision.
Also the only 2 units were the trial is occurring have both had their staffing levels cut at weekends???
Am concerned that if this is successful what next, are all controlled drugs going to be 1 Rn's signature????
Maybe im just a skeptic:uhoh3:
What do you think!!

gale

Gale

I agree with you to an extent that if this suceeds what will happen next. The reasons of 2 checking is a safety issue and to cut down on abuse.

I would do as domurray advises and get it checked out with the union, may also be worth asking pharmacy on any legal implications

bettyboop · Oct 16, 2005

HI

Since the oramorph trial began, I personally have noticed the drug being used much more often. I work permanent nights and order the controlled drugs from pharmacy and every night now without exception I order oramorph.

I did consult the pharmacy originally and they to are keeping records of use etc. I asked the legal implication especially as the drug is being used more often!! They said each practitioner is responsible for checking dosage and reaction, and potential overdose etc.

Have requested and been given guidelines by the pharmacy but these are just general i.e max 300 Mg in 24 hrs, which to me is a lot, but again the pharmacy stated its each Rn's responsibility to check.

Had a nurse the other night administer some to a pt, when asked why? as the pt ha not required opiate pain relief and was now 4 days post op, the nurse explained the pt was having difficulty sleeping:nono: when I asked why she hadn't had temazepam etc prescribed she said its its easier to give the oramorph:stone :eek: This is the only form of abuse of the drug I have seen up to now!! but am keeping a close eye on things.

Gale

Silverdragon102, BSN · Oct 16, 2005

HI
Since the oramorph trial began, I personally have noticed the drug being used much more often. I work permanent nights and order the controlled drugs from pharmacy and every night now without exception I order oramorph.
I did consult the pharmacy originally and they to are keeping records of use etc. I asked the legal implication especially as the drug is being used more often!! They said each practitioner is responsible for checking dosage and reaction, and potential overdose etc.
Have requested and been given guidelines by the pharmacy but these are just general i.e max 300 Mg in 24 hrs, which to me is a lot, but again the pharmacy stated its each Rn's responsibility to check.
Had a nurse the other night administer some to a pt, when asked why? as the pt ha not required opiate pain relief and was now 4 days post op, the nurse explained the pt was having difficulty sleeping:nono: when I asked why she hadn't had temazepam etc prescribed she said its its easier to give the oramorph:stone This is the only form of abuse of the drug I have seen up to now!! but am keeping a close eye on things.
Gale

I would be worried about giving oromorph to help sleeping, that is just being lazy and using medication inappropriately :uhoh21:

madwife2002, BSN, RN · Oct 16, 2005

HI
Since the oramorph trial began, I personally have noticed the drug being used much more often. I work permanent nights and order the controlled drugs from pharmacy and every night now without exception I order oramorph.
I did consult the pharmacy originally and they to are keeping records of use etc. I asked the legal implication especially as the drug is being used more often!! They said each practitioner is responsible for checking dosage and reaction, and potential overdose etc.
Have requested and been given guidelines by the pharmacy but these are just general i.e max 300 Mg in 24 hrs, which to me is a lot, but again the pharmacy stated its each Rn's responsibility to check.
Had a nurse the other night administer some to a pt, when asked why? as the pt ha not required opiate pain relief and was now 4 days post op, the nurse explained the pt was having difficulty sleeping:nono: when I asked why she hadn't had temazepam etc prescribed she said its its easier to give the oramorph:stone This is the only form of abuse of the drug I have seen up to now!! but am keeping a close eye on things.
Gale

Wow, cant believe what I am reading you are down to 1 rn and 1 hcsw at tnight for how many patients. We cut our staffing last week too but we have cut down to 2 RN's. What is happening to the NHS at the moment, god help us. Last week we were told no more wheelchairs as there is no money for them.

As far as the oramorph is concerned I would have worries on two aspects firstly re the possibility of aiding staff addiction, we all know it has gone on in the past, and secondly oramorph for sleeping sedation??? I feel that is abuse of opiates.

I know when we put up blood transfusions there only has to be I trained nurse doing the checking now. I am wondering if the rationale is the same.

madwife2002, BSN, RN · Oct 16, 2005

Check the codes from th NMC and be guided by them

karenG · Oct 16, 2005

bit of a move forward for us............but in some states in the USA oromorph is given to children the way we give calpol! the NPs can precribe it in the way i give out calpol or ibuprofen.

I had to think about that one!

Karen

safewaygreenbox · Oct 17, 2005

Hi all:)
Just wanted your opinion!!!
We have just started trials on our unit, were, if a pt requires oramorph, only 1 RN signature is required to dispense and you don't need 2 to administer etc only 1.
The rational given,for the trial is pt in pain waiting to long for pain meds???
The unit is a busy 24 bed surgical unit, at first (still am)was doubtful if it was for Pt's benefit as the management are now staffing the unit with 1 RN and 1 HCA at weekends on nights:angryfire. Still believe staff shortages and cutting costs of bank or agency nurses has a part to play in this decision.
Also the only 2 units were the trial is occurring have both had their staffing levels cut at weekends???
Am concerned that if this is successful what next, are all controlled drugs going to be 1 Rn's signature????
Maybe im just a skeptic:uhoh3:
What do you think!!

gale

What do I think? Oh my life!!! :stone Can I just check - You have 1RN and 1 HCA for 24 Beds on a surgical unit? On our ward we have 1RN and 1 HCA for 19 beds on weekend nights and I am thinking of putting in a formal complaint stating that I think it is dangerous and I'm not happy to take responsibility. They won't stand by you if something goes wrong and you havn't put in an incident form and reported that you feel understaffed before the start of the shift.

I would be more worried about staffing than the giving of oramorph as a 1 nurse procedure. IV's used to be a 2 nurse procedure - actually when I started nursing Drs did it :chuckle :chuckle

Where do you work?

:) :) :kiss

bettyboop · Oct 17, 2005

Hi

Work in an NHS hospital, on a surgical unit.

Officially we are supposed to go down to 7 Pt's at weekends, but never do!!!

the directorate manager said it all depends on pt dependency?? but as we all know it only take 1 poorly pt to increase the work load etc.

We have filled in incident form after incident form, have even refused to accept more admissions, but am constantly asked to do so. If I do accept a pt then the ward manager throws a paddy because she can't get her pre-op Pt's in.

In this hospital staff are leaving constantly or going off because of stress, but things are only going to get worse now the winter is coming:crying2:

After many yrs as an Rn, I to am leaving not only the NHS but the UK to. I want to continue to be an RN its what i love but see the NHS going down hill full speed:crying2: