title: Review of prescribing practices for intermittent bolus administration of morphine.
abstract: BACKGROUND
  Several changes to medication safety practices were proposed in a pediatric hospital, including changing the period of patient observation after administration of opioids and limiting the availability of various concentrations of morphine in the patient care unit.
  
  
  OBJECTIVE
  To document and review postoperative pain management for children on a surgical ward, specifically with regard to intermittent IV bolus administration of morphine, to help in assessing the impact of the proposed nursing practice changes.
  
  
  METHODS
  Data were collected from records for narcotics and controlled drugs for the surgical ward over a 3-month period (April to June 2006). For each patient, data had been recorded for up to 7 consecutive days after surgery. A patient's data were included in the review if he or she had received at least 2 doses of morphine by IV bolus, except for the review of weight-based dosing pattern (mg/kg), for which all patients who had received at least one dose of IV morphine were included.
  
  
  RESULTS
  Charts for 193 patients were audited. Of these, 163 patients (84.5%) had recieved up to 0.1 mg/kg per dose, and 53 (27.5%) had received only one dose of morphine. Among patients who received more than one dose, the median dose was 0.080 mg/kg on day 1, with a decrease by day 5 to 0.065 mg/kg. Most patients received morphine over the first 2 days after surgery. The median time elapsed between doses was 4.3 h on day 1 and 6.2 h on day 2. Of the 1020 doses included in the analysis, most (801 [78.5%]) were 4 mg or less.
  
  
  CONCLUSIONS
  The intermittent administration of IV bolus doses of morphine at the study hospital followed common standards for the treatment of postoperative pain. Most doses were no more than 4 mg. On the basis of this information, only 2-mg vials of morphine are now stocked on the ward. The hospital's change in monitoring practices will increase the surveillance of patients receiving IV bolus doses of morphine.
authors.affiliation: , BSc(Pharm), PharmD, is with the Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario. At the time of the study, he was a PharmD student with the University of Toronto.
authors.forename: Keith
authors.initials: K
authors.lastname: Sine
authors.forename: Régis
authors.initials: R
authors.lastname: Vaillancourt
authors.forename: Elena
authors.initials: E
authors.lastname: Pascuet
authors.forename: Brenda
authors.initials: B
authors.lastname: Martelli
authors.forename: Christine
authors.initials: C
authors.lastname: Lamontagne
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Ellis
authors.forename: Elaine
authors.initials: E
authors.lastname: Wong
authors.forename: Isabelle
authors.initials: I
authors.lastname: Gaboury