Risk Control Strategies for Reducing Patient Harm with HYDROmorphone
Reprinted with permission from the Institute for Safe Medicine Practices

  • Differentiate HYDROmorphone from morphine where both products are available (use tall man lettering on labels, order sets, order entry screens, medication administration records, etc.)
  • Include the brand name Dilaudid on order sets, order entry screens, medication administration records, etc., to help differentiate HYDROmorphone from morphine
  • Limit the number of strengths available (e.g., do not stock HYDROmor

    phone 4 mg prefilled syringes in all patient care areas)

  • Avoid stocking HYDROmorphone injection in prefilled syringes in the same strength as morphine prefilled syringes (e.g., do not stock morphine 2 mg and 4 mg and HYDROmorphone 2 mg and 4 mg)
  • Post equianalgesic dosing charts in patient care areas, in computerized prescriber order entry systems and pharmacy information systems, and on medication administration records
  • Limit the starting doses of HYDROmorphone to 0.5 mg (particularly for opioid naĂ¯ve patients and those with other risk factors such as obesity, asthma, obstructive sleep apnea or those receiving other medications that can potentiate the effects of HYDROmorphone)
  • Employ technology to alert practitioners, (e.g., barcode medication verification, hard stops in smart infusion pump libraries for catastrophic doses)
  • Perform independent double checks when HYDROmorphone is removed from stock, particularly if a pharmacist has not reviewed the order prior to drug administration
  • Strongly consider employing capnography to monitor patients on patient‑controlled analgesia