MORPHINE USE AND ADVERSE-EFFECTS IN A NEONATAL INTENSIVE-CARE UNIT

Prescribing patterns and appropriateness of morphine use in a neonatal intensive care unit (NICU) were evaluated in a concurrent drug-use ev aluation (DUE). Data were collected for 99 infants who received morphi ne over a six-month period. Patient charts were reviewed to collect th e following data: patient's age, weight, dosage schedule, concurrent s edatives, ventilatory status, whether adequacy of analgesia was docume nted, and descriptions of adverse drug reactions (ADRs). The physician s' orders were reviewed to determine whether NICU morphine dosage guid elines were followed and whether the indication for use was noted. Sev en ADRs occurred in six of the patients; three of the ADRs occurred af ter ophthalmic cryosurgery. Indications for use were noted in 79 of 28 5 physician orders (27.7%). The adequacy of sedation or analgesia was documented on 60 of the 360 patient days (16.7%). The DUE results prom pted several changes: physicians were asked to select indications from a list in the computerized order-entry system, an analgesia or sedati on assessment scale was added to nursing flow sheets, and endotracheal intubation became a requirement before ophthalmic cryosurgery. A foll ow-up DUE showed nearly complete compliance with the new guidelines fo r morphine use and a reduction in the number of adverse reactions to m orphine. A DUE prompted policy changes that improved documentation of indications for and efficacy of morphine use and reduced adverse react ions to the drug in an NICU.