Resources & Tools

CAPHC and ISMP Canada are grateful for the information shared by participating healthcare organizations.

1. Standard Concentrations
   1. Monographs
   2. Pump flow limits:
   3. Dosing Charts
   4. Order Sets
      1. Medication Order Policies & Standards
      2. Patient Controlled Analgesia (PCA)
      3. Opioid Infusions
      4. Patient Order Sets.com
2. Dosing and Administration
   1. Drug Calculation Program:
   2. Equianalgesic Charts:
3. Monitoring Guidelines
   1. Weaning Opioids and Withdrawal
   2. Naloxone Guidelines:
4. Labelling and Storage
5. Implementation

Standard Concentrations

Monographs

1. Morphine
   • BC Children's Hospital (see attachment)
   • Children's Hospital of Eastern Ontario (see attachment)
2. Fentanyl
   •  BC Children's Hospital (see attachment)
   • Children's Hospital of Eastern Ontario (see attachment)
3. Hydromorphone
   • BC Children's Hospital (see attachment)
   • Children's Hospital of Eastern Ontario (see attachment)

Pump flow limits:

1. Alaris Infusion Pump Drug Library Settings for Opioids (see attachment)
2. CHEO  Smart Pump Limits for Paediatric Opioids (see attachment) 

Dosing Charts

1. Infusion dosing charts for standard concentrations (for use where smart pump technology is not available) (see attachment)

Includes:

• Morphine 0.2mg/mL (200mcg/mL)
• Morphine 1 mg/mL
• Hydromorphone 40mcg/mL
• Hydromorphone 250mcg/mL
• Fentanyl10mcg/mL
• Fentanyl 50mcg/mL

Order Sets

ISMP Guidelines for Standard Order Sets (see attachment)

Medication Order Policies & Standards

1. WRHA Medication Order Writing Standards (see attachment)
2. BC Children's Continuous Morphine Infusion Guidelines (for patient's under 3 months of age); Preprinted Order CMI under 3 months of age; Policy CMI in Post Surgical infants less than 3 months of age
3. BC Children's Patient Controlled Analgesia Guidelines; PCA Physician's Order; PCA Policy

Patient Controlled Analgesia (PCA)

1.  TOOL KIT Patient Controlled Analgesia (PCA) Guidelines of Care For the Opioid Naïve Patient - San Diego Patient Safety Council (see attachment)
2. Physician Orders for Patient Controlled Analgesia - Children's Hospital of Eastern Ontario (CHEO) (see attachment)
3. Physician's Orders for Patient Controlled Analgesia

Opioid Infusions

1. Physician Orders for Continuous Opioid Infusion Children's Hospital of Eastern Ontario (CHEO) (see attachment)
   

Patient Order Sets.com

1. Introduction to PatientOrderSets.com
2. Pediatric ER Intermittent Pain Management Order Set (see attachment)
3. Pediatric ER Sickle Cell Disease: Acute Painful Episode Order Set (see attachment)
4. Pediatric IV morphine Infusion Order Set (see attachment)

Dosing and Administration

Drug Calculation Program:

The CHEO Drug Calculation Programs are a medication safety tool designed to assist with the calculation of pediatric drug dosages and infusion rates. The tool was developed for use at CHEO and is based on the concentrations and dosages used at that institution.  Patient specific dosages and infusions rates are calculated by entering a patient weight into the appropriate entry fields. The tool serves as a resource in the medication safety process to help verify accuracy of pediatric drug calculations. Please click the link to use the CHEO Drug Calculation Program

1. Manual Verification Independent Double Check Aid (Attachment)
2. Opioid Calculation Aid (see attachment)
3. CHEO Pediatric Doses of Commonly Prescribed Medications ( see attachment)

Equianalgesic Charts:

1. The Hospital for Sick Children Drug Handbook and Formulary 2010 -2011

Monitoring Guidelines

Weaning Opioids and Withdrawal

1. Children's Hospital of Eastern Ontario lunch and learn presentation (see attachment)

Protocols:

1. Pain Management Documentation Flowsheet -  BC Children's Hospital (see attachment)

Naloxone Guidelines:

1. Pain Management: Naloxone Administration for Opioid Induced Respiratory Depression - BC Children's Hospital (see attachment)
2. Naloxone dosing and administration guidelines - IWK Heath Centre (see attachment)

Labelling and Storage

(ISMP Canada Medication Safety Support Service Narcotics (Opioids) Toolkit January 2005, Version 1)

Labels With the End User in Mind - ISMP Canada Safety Bulletin, Volume 2, Issue 9

Implementation

1. Implementing Standard Concentrations Checklist (see attachment)
2. Opioid Safety Implementation Checklist (see attachment)