practice partner
Patient Safety
We use this forum to regularly report on findings from patient safety organizations, expert review
committees of the Office of the Chief Coroner, and inquests.
Consider patch
if patient unable
to swallow
long-acting pain
medication
T
he Geriatric and Long-Term Care Death
Review Committee – a committee which
reports to the Chief Coroner – had made
some recommendations to health-care
professionals following its investigation in the death
of a 71-year old woman who had been prescribed
opioids.
The Committee made a number of recommenda-
tions it its report, which emphasized the importance
of an early assessment and medication review for
frail, elderly seniors who are admitted to a long-term
care home. This is especially true for high-risk indi-
viduals who have diagnoses such as liver or kidney
failure and who are on diuretics and narcotics.
The Committee also reminded physicians to:
omplete an in-person assessment when making
c
significant changes in dosing of opioids. Increases
should be limited to 10% above the previous day’s
dose.
onsider using a patch if a patient is unable to
c
swallow a long-acting pain medication. Such medi-
cations should not be crushed.
hen switching to different opioids, the initial
w
starting dose should be 50% of the morphine
equivalent of the current opioid.
Background
The woman had an extensive medical history. When
she was admitted to the long-term care hospital on
June 25, 2014, the medical director and attending
physician were on vacation. She continued to com-
plain about pain from a recent fall, so her medica-
tion was adjusted by contacting the physician in the
emergency department of the local hospital. She was
initially prescribed 4 mg of hydromorphone per day,
usually in the dose of 1 mg on an as needed basis.
This did not provide her adequate pain relief and
on June 28, 2014, the emergency department was
contacted and the hydromorphone was increased to 3
mg every two hours on an as needed basis. Her total
daily dose of hydromorphone could not be deter-
mined upon review of the notes.
On June 27, 2014, lab results indicated that the
Issue 2, 2017 Dialogue
47