Saturday, August 12, 2006

Underdosing of morphine in hospitals; DEA; NPR

The current Pain Medicine has a few interesting articles...

A brilliantly simple comparison of the dosing of IV morphine vs. hydromorphone vs. meperidine at a hospital.  The authors found that the median dose of morphine given was 2mg (!) wheras the median doses of hydromorphone and meperidine used were equivalent to 13mg and 7mg of morphine, respectively.  This is a great study because it demonstrates a major quality of care problem using simple methodology and outcomes, with dramatic results.  Would be curious to see if people think this is a problem at their institutions.  Besides not using meperidine at my institution, opioid equianalgesic tables are all over the place, on the opioid order forms themselves, etc., and while I do think this is a problem it's not quite as ridiculous as in this study. 

There are also several articles about the ongoing debate/controversies surrounding DEA actions against pain docs.  There is one paper presenting data on the number of actions (suggesting they are miniscule) and a bunch of commentaries calling that bluff

NPR this week had a few in-depth stories about the palliative care program at the Children's Hospital of Philadelphia.  Well worth listening to. 

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