Oramorph: only one signature (TRIAL)

[bettyboop]

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

[Owain Glyndwr]

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

Surely the issue here (apart from the poor staffing) is the proportion of Morphine in the solution which determines whether it is a CD or POM? The BNF states, and has done for as long as I remember, that if the solution is above 13mg/5ml it becomes a CD. Therefore, any 'normal' Oramorph (10mg/5ml) is treated like any other prescribed medicine and dispensed by one trained nurse. That's the legal bit. The NMC have no comment as there is no need for them to.

I have practiced this in several Trusts in the UK for over 15 years, and also have practiced one registered nurse + one other (healthcare staff) CD checking and administration.

As mentioned, it's often down to Trust policy and a matter of safety.

Cheers

OG

[Silverdragon102, BSN]

Surely the issue here (apart from the poor staffing) is the proportion of Morphine in the solution which determines whether it is a CD or POM? The BNF states, and has done for as long as I remember, that if the solution is above 13mg/5ml it becomes a CD. Therefore, any 'normal' Oramorph (10mg/5ml) is treated like any other prescribed medicine and dispensed by one trained nurse. That's the legal bit. The NMC have no comment as there is no need for them to.

I have practiced this in several Trusts in the UK for over 15 years, and also have practiced one registered nurse + one other (healthcare staff) CD checking and administration.

As mentioned, it's often down to Trust policy and a matter of safety.

Cheers

OG

That I can understand but then why then do the pharmacies at the hospitals where I previously worked insist it is treated as CD and ordered and dispenced as CD if I remember rightly does was 10mg/5ml?

Just a thought

[bettyboop]

There are 2 doses of oramorph in our CD cupboard one is 10mg/5ml the other is 20mg/1ml.

Both are treated as a CD'S and up until the trial began had to be dispensed and administered by 2 Rn's.

The other problem I'm am trying to over come as far as staffing levels is, all IV medication including flushes and IV fluids are to be double checked with 2 Rn's, at the beginning of the shift I check with the late staff IV antibiotics etc prescribed at 2200 hrs and assess Pt's IV infusions and get them checked on the late shift, but there is always anti-emetics, flushes etc were I have to call another ward to get an RN to check them.

Yes I have worked on many wards were there is only 1 RN and 1 HCA but this does not mean it's safe to do so.:stone

As many hospitals my hospital is over budget and managers are not allowed to employ agency etc, and very few bank nurses are willing to work weekend nights, so even when pt dependency is increased more often than not we still work 1 & 1.

[english_nurse]

hi everyone,

we have been dispensing oramorph without having to check with another rn for about a year, we keep it in the drug trolley, not the cd cupboard, this means it can be dispensed without delay if needed, i am unsure if useage has increased as i have only been qualified two years so i dont think ive been around long enough really!

staffing levels have decreased massively in the past two years, the surgical ward next to mine only has 1 rn and 1 hca for 24 pts at night, if any of the beds are empty they are soon filled with overnight admissions or unstable medical patients which can be very dangerous, a few nights ago we had a drunk who had drank everything in the house including all the cleaning fluids and was very agitated and violent the staff and patients were very scared.we are not allowed extra staff or bedwatch as it costs too much, so the staff are put at risk! no wonder we are all leaving in droves, or off sick all the time what do they expect? how can a buisiness be allowed to operate so badley? any other place would be shut down by health and safety, nurses traditionally dont shout when they are hard done by at work, maybe its time we spoke out all together, for the sake of ourselves and the patients.