VCH Practice Alert KADIAN : a unique morphine long acting capsule - - PDF document

Date: March 14, 2018 Site(s):VCH all sites

SITUATION/BACKGROUND: Morphine long acting capsules are available in different formulations:  KADIAN caps- 24 hour release formulation  M-ESLON caps or MS CONTIN tabs – 12 hour release formulation

 KADIAN is used to treat patients with known Opioid Use Disorder and/or Chronic Pain.  Although KADIAN is meant for ONCE daily dosing, sometimes it is dosed more frequently.

ACTION / RECOMMENDATION:  Only a Pharmacist Physician or Nurse Practitioner can substitute or interchange KADIAN for another morphine product, which requires calculating the correct interchange dosing FOR MORE INFORMATION:  For more information contact your clinical educator or Pharmacist VCH: Issued by Regional Professional Practice Practice Alerts are posted online @ VCH Practice Alerts/Updates

VCH Practice Alert

KADIAN: a unique morphine long acting capsule

VCH Professional Practice - Best Practice, Best Care

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Regional Professional Practjce—Best Practjce—Best Care

Medicatjon Safety Huddle

Volume 1, Issue 1 April, 2018

morphine (KADIAN) long actjng capsules

Site(s): All sites



Sample medication package label

KADIAN, a 24 hour release long actjng mor- phine capsule, has been added to formulary. It is difgerent from other long actjng mor- phine products. M-ESLON, for example, is a 12 hour release formulatjon. How is KADIAN ordered? Prescribers ordering morphine KADIAN long actjng capsules must: Specify the BRAND NAME and/or Indicate a 24 hour long actjng formulatjon NOTE: a clarifjcatjon is required if the BRAND name KADIAN *OR* release dura- tjon/hours is not specifjed. These are both indicators for morphine (KADIAN) long actjng capsules. Prior to administratjon, verify the KADIAN nomenclature on.



Medicatjon packaging



ADC (Omnicell) alerts (where in use)



Medicatjon Administratjon Record

For more informatjon contact: Your local Professional Practjce Lead or Pharmacy Deb Halket, Regional Practjce Lead-Medicatjon Safety and Management @ Debra.Halket2@vch.ca

Please Post

Case Study: A patjent was ordered morphine (KADIAN) long actjng 100mg capsule. The nurse administered morphine (M-ESLON) long actjng instead of ordered morphine (KADIAN) long actjng 100 mg capsule. The patjent be- came drowsy. With investjgatjon, the nurse realized that the patjent received TWICE the intended dose of morphine! Why did the patjent receive TWICE the dose? All 100mg of morphine was released over a 12 hour period rather than the intended 24 hour period.

KADIAN M-ESLON

Special administratjon instructjons are indicated for morphine capsules, including KADIAN, when prescribed for patjents with Opioid Use Disorder (OUD). The capsules must be opened and sprin- kled over applesauce and patjent ingestjon must be witnessed by the nurse. The ratjonale behind sprinkling KADIAN is to avoid diversion; this prac- tjce is recommended in OUD treatment guide- lines.

Regional Professional Practjce—Best Practjce—Best Care

Medicatjon Safety Huddle

Volume 1, Issue 2 April , 2018 For more informatjon contact: Your local Professional Practjce Lead or Pharmacy Deb Halket, Regional Practjce Lead-Medicatjon Safety and Management @ Debra.Halket2@vch.ca

Please Post

morphine long actjng capsule orders: know the risks

Site(s): All sites

Long actjng morphine can display/appear in difgerent ways on the PharmaNet MedRec Order form

Seek Clarifjcatjon: No Brand name *OR* duratjon/hours of release

KADIAN M-ESLON

*OR* OTHER

There are difgerent formulatjons for long actjng morphine capsules. For example:

morphine (KADIAN) long actjng 100 mg CAP

KADIAN is released over 24 hours

morphine (M-ESLON) long actjng 100 mg CAP

M-ESLON is released over 12 hours

How are these capsules ordered?

Prescribers ordering long actjng morphine capsules must:  specify the BRAND NAME and/or  indicate a 24 hour long actjng formulatjon or  indicate a 12 hour long actjng formulatjon

SAFETY TIP: A clarifjcatjon is required if the

BRAND name or the RELEASE formulatjon of the morphine long actjng capsules is not specifjed on the

• rder.

Nomenclature for long actjng morphine formulatjons will be consistent on:

 ADC dispensing alerts, where available (to mitjgate selectjon error)  the medicatjon packaging  the Medicatjon Administratjon Record (MAR) Administering the wrong formulatjon (duratjon/hours of re- lease) can cause signifj- cant harm to patjents and could result in an

• verdose.

When selectjng a mor- phine long actjng cap- sule, pay close atuen- tjon.