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General Operational Topics

Next Reply: Re:Continuous morphine drips
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Post Continuous morphine drips
Author: beachbum
Date: Feb 27, 2009 10:07 am
Hello, we are looking to formulate a policy to cover the use of MS gtts at end of life. we have a policy for PCA administration, but this doesn't cover or address our needs. If anyone has a policy and can share we would appreciate. Thanks Ronnie
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Re:Continuous morphine drips (by mrabow on 03/02/2009)
Hi,

We don't have a separate policy about IV analgesia at the end of life. One of the most important points about the "morphine drip" is that it is not theoretically any different than continuous IV pain management for symptoms at any other time. That is, the morphine drip is to control symptoms, not to hasten death. This should be at the center of any policy.

Here is the fast facts on it.
http://www1.va.gov/HCBC/pagetext.cfm?pg=31#8

and one on dose escalation
http://www1.va.gov/HCBC/pagetext.cfm?pg=31#20

There is some evidence that with patients "on a morphine drip," physicians tend to increase doses without evidence that the patient is having unrelieved symptoms (?difficulty with the waiting). So, if you develop a separate policy, it would be good to include a list of indications for bolus or increase basal rate dosings, e.g. pain or shortness of breath in a conscious patient or tachypnea, grimacing, agitation, or apparent pain in a non-communicative patient. On our service, we check in frequently with the family for their assessment about whether their loved one is in pain.

best,
Michael W. Rabow, MD
UCSF Palliative Care Leadership Center
Re:Continuous morphine drips (by Weissman on 03/02/2009)
There is an a sample opioid policy on page 22 of the CAPC "Policies and Tools for Hospital Palliative Care Programs; A Crosswalk of national Quality forum Preferred practices". On Pages 65/66 are the standard order forms adapted to fit this policy, which is used by our palliative care program. The CAPC book is available at no charge from CAPC.Org.

Download the CAPC's NQF Crosswalk here:
http://www.capc.org/support-from-capc/capc_publications/nqf-crosswalk.pdf/view?searchterm=crosswalk

David E. Weissman, MD
Professor, Palliative Care
Medical College of Wisconsin
Palliative Care Leadership Center
Milwaukee, WI

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