Hello.

I am new to the med safety role & in need of some expert advice on a process that is new to our facility.

Our anesthesiologists assist with pain managment at our hospital and a new physician has a practice of having nurses dilute dilaudid 1mg in 10mL normal saline and infusing it over 15 minutes to avoid "patient conflation of opioid-induced euphoria vs. true analgesic benefit."

I have informed our Pharmacy leadership team of the risks involved with allowing nurses to prepare this high alert medication at the bedside (i.e. use of saline flushes for dilution and not labeling the syringe), but have been informed that "as long as Pharmacy provides Nursing with the appropriate education then whatever happens after that is up to Nursing."

As an aside, Nursing does reconstitute other medications at the bedside (e.g. cefazolin) for IV push.

Question: As a med safety pharmacist, besides making sure that there is a process outlined for nurses to use normal saline vials to prepare this dose and making sure that it is labeled, what other safeguards should I consider?

Thank you in advance!

Vee