Question: My question is about pain management. Our directive states a maximum of 4 doses of 25-50mcg fentanyl (200mcg max) or 2-5mg morphine. (20mg max). Is there a reason we could not just have a max total dose of 200mcg/20mg and be able to give, say, 8x25mcg fentanyl q5? I feel that with the increasing frequency of offload delays it could be beneficial to the patient for us to have the ability to spread the maximum dosage out over a longer duration.

Thanks for your question and interesting thoughts. You raise valid points. The alternative here would be to alter your dosing to the higher dose so that you may achieve effective analgesia more rapidly for your patient then require less frequent administration. A ceiling of 200mcg of fentanyl and 20mg of morphine is still a relatively high dose for the majority of patients. If your patient is still in significant pain while on off load despite this dose, reconsider your CTAS scoring and as always, a patch to the BHP for further analgesia orders should also be considered.

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