To: Nursing, Pharmacy, Physician Staff
From: Maryna Shayuk, Chair Pharmacy and Therapeutics
Alan Mader, Pharmacy Clinical Coordinator
Re: Drug Shortage: 0.45% NS liter bags
|0.45% NS in liter bags have been placed on shortage at this time.|
|This shortage was unexpected and was announced today.|
|Substitution during this shortage will be necessary|
|Pharmacy will utilize the following plan to substitute orders written for 0.45% NS:|
0.45% NaCl to 0.9% NaCl – for pre & post-surgery.
If patient is hypernatremic, substitute with Lactated Ringers.
All other orders call MD.
Pharmacy services will place “Substituted for ________” in the comment section of the Paragon order so that nursing is aware of the change.
Morphine Injection Shortage 10.18.2017
There is a nationwide shortage of morphine injection that expected to last until early to mid-November. The Pharmacy Department is running very low on supply and expects that the drug will become unavailable. Please consider ordering an alternate injection product for pain management. An opioid dose conversion chart is included below for your convenience.
Oral: Parenteral Ratio
Oral Morphine: Analgesic Ratio
|Morphine||30 mg||10 mg||3 : 1||1 : 1||4 – 6 hrs||3 hrs|
|Oxycodone||20 mg||—||—||1.5 : 1||3 – 5 hrs||4 – 5 hrs|
|Hydromorphone||7.5 mg||2 mg|| 4: 1||4: 1||3 – 4 hrs||2 – 3 hrs|
|Fentanyl||—||100 mcg||—||See Table B on page 2||1 hr||3 – 12 hrs|
|Methadone||20 mg||10 mg||2 : 1||See Table C on page 2||4 – 12 hrs||15 – 50 hrs|
|Codeine||200 mg||130 mg||1.5 : 1||1 : 7||4 – 6 hrs||3 hrs|
|Hydrocodone||30 mg||—||—||1 : 1||3 – 6 hrs||3 – 4 hrs|
|Meperidine||300 mg||75 mg||4 : 1||1 : 10||2 – 4 hrs||2 – 3 hrs|
|Nalbuphine||—||10 mg||—||1 : 1||3 – 6 hrs||5 hrs|