Dosing buttons coming for opioid infusions March 2

Fixed titration instruction in the MAR; in compliance with TJC

Starting March 2, new buttons to improve the appearance of titration instruction in the MAR and ensure that our dosing instructions are compliant for all nurse-titrated infusions. These changes apply to infusion orders for the opioids fentanyl, hydromorphone and morphine.

In order entry, you will see:

     Future State —

     
Current state: Titrate for patient’s expressed level of pain or observed level of comfort. Keep respiratory rate greater than 10. Start at 25 mcg/her. Bolus 25 mcg OR 25 to 50% of basal rate (whichever is greater) every 15 minutes as needed. May increase dose by 25 mcg/her if 3 or more PRN doses are given in 2 hours. Initial upper limit: 100 mcg/her. Call physician if larger dose is necessary or infusion rate increased more than 3 times within 6 hours.

On the MAR, you will see (future state):

Current state:

Why the change?

In our last Joint Commission survey, we were cited for inadequate titration instructions for an order for a nurse-titrated infusion (Pitocin). We fixed the immediate problem, and now applying this to other medications to ensure compliance of other infusion orders as well. Similar buttons have already been added to infusions for most other nurse-titratable infusions. If you have questions, concerns, or suggestions for other buttons that you would use frequently, contact Matt Tanner in Pharmacy (503-814-9960 or matthew.tanner@salemheath.org).