Implementation

• High Alert: Accidental overdose of opioid analgesics has resulted in fatalities. Before administering, clarify all ambiguous orders; have second practitioner independently check original order, dose calculations, and infusion pump settings. Do not confuse with morphine or hydromorphone; fatalities have occurred. Pedi: Medication errors with opioid analgesics are common in the pediatric population and include misinterpretation or miscalculation of doses and use of inappropriate measuring devices

• Explain therapeutic value of medication prior to administration to enhance the analgesic effect

» Regularly administered doses may be more effective than prn administration. Analgesic is more effective if given before pain becomes severe

» Coadministration with nonopioid analgesics may have additive analgesic effects and permit lower doses

» Oral dose is <50% as effective as parenteral. When changing to oral administration, dose may need to be increased (see Equianalgesic Dosing Guidelines)

» Medication should be discontinued gradually after long-term use to prevent withdrawal symptoms

» May be administered via PCA pump

• PO: Doses may be administered with food or milk to minimize GI irritation. Syrup should be diluted in half-full glass of water

• IM: Administration of repeated subcut doses may cause local irritation

IV Adminstration:

• Direct IV:
Diluent: Dilute with sterile water or 0.9% NaCl for injection
Concentration: <=10 mg/ml

• Rate:
High Alert: Administer slowly over at least 5 min. Rapid administration may lead to increased respiratory depression, hypotension, and circulatory collapse

• Intermittent Infusion:
Diluent: Dilute with D5W, D10W, dextrose/saline combinations, dextrose/Ringer's or lactated Ringer's injection combinations, 0.45% NaCl, 0.9% NaCl, or Ringer's or LR. Administer via infusion pump.
Concentration: 1 mg/ml

• Rate:
Administer over 15–30 min.

• Syringe Compatibility:

» atropine

» chlorpromazine

» cimetidine

» dimenhydrinate

» diphenhydramine

» droperidol

» glycopyrrolate

» hydroxyzine

» ketamine

» metoclopramide

» midazolam

» ondansetron

» perphenazine

» prochlorperazine

» promazine

» promethazine

» ranitidine

» scopolamine

• Syringe Incompatibility:

» heparin

» morphine

» pantoprazole

» pentobarbital

• Y-Site Compatibility:

» amifostine

» amikacin

» ampicillin

» ampicillin/sulbactam

» atenolol

» aztreonam

bivalirudin

» bumetanide

» cefazolin

» cefotaxime

» cefoxitin

» ceftazidime

» ceftizoxime

» ceftriaxone

» cefuroxime

» chloramphenicol

» cisatracurium

» cladribine

» clindamycin

» dexamethasone

» dexmedetomidine

» digoxin

» diltiazem

» diphenhydramine

» dobutamine

» docetaxel

» dopamine

» doxycycline

» droperidol

» erythromycin lactobionate

» etoposide phosphate

» famotidine

» fenoldopam

» filgrastim

» fluconazole

» fludarabine

» gemcitabine

» gentamicin

» granisetron

» heparin

» hydrocortisone sodium succinate

» insulin

» kanamycin

» labetalol

» lidocaine

» linezolid

» magnesium sulfate

» melphalan

» methyldopate

» methylprednisolone

» metoclopramide

» metoprolol

» metronidazole

» ondansetron

» oxacillin

» oxaliplatin

» oxytocin

» paclitaxel

» pemetrexed

» penicillin G potassium

» piperacillin/tazobactam

» potassium chloride

» propofol

» propranolol

» ranitidine

» remifentanil

» sargramostim

» teniposide

» thiotepa

» ticarcillin/clavulanate

» tobramycin

» trimethoprim/sulfamethoxazole

» vancomycin

» verapamil

» vinorelbine

• Y-Site Incompatibility:

» allopurinol

» amphotericin B cholesteryl sulfate

» cefepime

» cefoperazone

» doxorubicin liposome

» idarubicin

» imipenem/cilastatin

» lansoprazole

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