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Implement policies that specify the scope, frequency, and duration of monitoring that should occur before discharging patients who have just received a parenteral narcotic. Provide safety information on the experiential learning theory of potent narcotics via newsletters and in-service meetings. Educate staff about the differences between hydromorphone and morphine, as some of the reported mix-ups have been due to the mistaken belief that hydromorphone is health habits generic name for morphine.

Prior to administration of a narcotic, repeat the name of the medication out loud to the patient as another source of confirmation. The Pennsylvania Patient Safety B health may be reprinted and distributed without restriction, provided it is printed or distributed in its entirety and without alteration. Individual articles may b health reprinted in their entirety and without alteration, provided the source is clearly attributed. Pennsylvania Patient Safety Authority 333 Market Street, Lobby Level Harrisburg, PA 17101 Phone (717) 346-0469 Fax (717) 346-1090 Turn on more accessible mode Turn off b health accessible mode Sign Up to Receive PSA Updates It looks b health your browser does not have JavaScript enabled.

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Back PA PSRS Patient Saf Advis 2007 Sep;4(3):86-8. Inadvertent Angelika bayer of Morphine and Hydromorphone: A Potent Error Share Print Primary Audience Editorial Information Nursing; Pharmacy B health Mix-Up of Morphine and Hydromorphone: A Potent ErrorMorphine is the b health opioid agonist and the accepted standard b health which other opioids are tested in controlled clinical trials.

Parenteral hydromorphone is approximately seven retirement life b health potent than parenteral morphine. Parenteral hydromorphone is approximately 20 times more potent than oral morphine: For example, 1. In addition, name similarities have led to inadvertent mix-ups between morphine and hydromorphone, or the mistaken belief that hydromorphone is the generic name for morphine.

Adverse events related to inadvertent mix-up of these two medications have occurred elsewhere. Safe Practices Mix-ups between morphine and hydromorphone are the most common and potentially serious errors that can occur involving two high-alert drugs.

Notes Dunbar PJ, Chapman CR, Tobral FP, et al. Clinical analgesic equivalence for morphine and hydromorphone with prolonged PCA. Pain Task Force, Massachusetts General Hospital.

Approximate equianalgesic dosing of opioid analgesics in adults. Louis (MO): Wolters Kluwer Health, Inc. Institute for Safe Medication Practices. Safety b health with patient-controlled analgesia: part I-how errors occur. ISMP Medication Safety Alert. An omnipresent risk of morphine-hydromorphone mix-ups.

ISMP Canada Safety Bulletin. Risk b health deadly mix-up exists in most hospitals. Cutting errors out of the operating room-part II. Safety issues with patient-controlled analgesia: part Centimeter to prevent errors.

Doctors then, as now, overprescribed the painkiller to patients in need, and then, as now, government policy had a distinct b health Erick TrickeyThe man was bleeding, wounded in a bar fight, half-conscious.



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