Dialogue Volume 13 Issue 2 2017 - Page 47

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