Postoperative Clinical Monitoring After Morphine Administration: A Retrospective Multicenter Practice Survey.

BACKGROUND The objective of this survey was to describe the clinical monitoring practically used after intravenous, subcutaneous or neuraxial (epidural or intrathecal) administration of morphine. METHODS It was a descriptive, retrospective, multicenter (10 hospitals) survey based on the medical charts' analysis, which evaluated the postoperative clinical monitoring after morphine administration. RESULTS Morphine was delivered intravenously (69%), intrathecally (19%), epidurally (10%) and/or subcutaneously (12%). Clinical monitoring protocols and protocols for the management of side effects were both present in 60% (n=6/10), only one of the two types of protocols in 10% (n=1/10) and both absent in 30% (n=3/10). Protocols for the management of respiratory depression and consciousness evaluation were present in 70% of cases (n=7/10). These events were reported on medical records without any prescription or protocol in 35% (n=14/40) and 37,5% (n=15/40) respectively. Prescriptions for respiratory rate evaluation and clinical monitoring of consciousness were in agreement with only 20% of the medical data and medical records. Different levels of respiratory rate were observed: 43% (n=3/7) below 8/min, 43% (n=3/7) below 10/min and 14% (n=1/7) below 12/min. Clinical monitoring was not performed in 31% (n=31/100) for consciousness and in 35% (n=35/100) for respiratory rate. Pulse oximeter was used in 48% (n=48/100) of patients. Capnography was never used. Respiratory depression occurred in 1% (n=1/100) of cases. CONCLUSION This survey emphasizes an important disparity in the prescription of medical monitoring and a lack of use of protocols when morphine is administered. It demonstrates the need for a standardization of protocols according to the existing guidelines.

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