Aim: To monitor the morphine doses administered, complications and nursing staff satisfaction after the implementation of an intravenous opioid policy for children.
Methods: Nursing staff were empowered to administer five incremental doses of intravenous morphine (age >1 year, 0.04 mg kg−1; age <1 year, 0.02 mg kg−1) for postoperative analgesia on the surgical wards. Inherent in this policy was a nursing educational process and improved physiological monitoring. An audit was performed after two months. Data were compared with those collected from an historical control group over a three-month period before introduction of the opioid policy
Results: There was no difference between mean (SD) daily morphine doses administered before (day 1, 0.087 (0.093); day 2, 0.064 (0.09); day 3, 0.022 (0.07) mg kg−1) or after (day 1, 0.090 (0.091); day 2, 0.067 (0.011); day 3, 0.014 (0.047) mg kg−1) the protocol was introduced. Ninety percent of children charted protocol morphine were given morphine on day 1, compared to 70% in the pre-protocol group. A larger daily dose of paracetamol was continued until day 3 in the protocol group (39 vs 9 mg kg−1, p=0.002). No adverse effects in either group were noted. Nursing staff reported a high level of satisfaction with the protocol at a six month review.
Conclusion: We report the successful implementation of an intravenous opioid policy. Morphine use did not increase. However the education process resulted in an increased awareness of pain and its management in children. Although potential for drug errors still exists, these errors are a consequence of system error and goals of zero drug error rates should be aggressively sought with systems in place that seek to eliminate the effects of inevitable human error. This opioid protocol is one such system.
