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11/16/20 md New alert at verification for morphine oral CONCENTRATE
November 18, 2020

From: "Michele Durda" <michele.durda@hhsys.org>
To: "Pharmacists" <grp_allpharm@hhsys.org>
Sent: Monday, November 16, 2020 2:30:09 PM
Subject: New alert at verification for morphine oral CONCENTRATE

Beginning today, the following alert will appear on verification of morphine oral CONCENTRATE:

ALERT: This is morphine oral CONCENTRATE (20 mg/mL)

1. Check the route - the CONCENTRATE should be used for sublingualadministration; if the patient is able to swallow -or-  the medication is ordered per tube, switch to the standard oral liquid (2 mg/mL)
2. Check the dose - to facilitate dispensing of the exact ordered amount, doses are limited to 2 mg or increments of 5 mg; contact the provider to adjust the dose if needed
3. Check the product assignment - dispensed as prefilled syringes (2 mg, 5 mg, 10 mg, or 20 mg); be sure the correct syringe size is assigned to the order  (order may require multiple syringes)

The concentrated oral liquids for both morphine and oxycodone are intended for SUBLINGUAL administration in patients unable to swallow. The high concentration is needed to reduce the volume and achieve a concentration gradient large enough to facilitate absorption via this route. Please be sure that the ordered route is SUBLINGUAL (all order sentences in PowerChart have been updated to the SL route) and that the order has product assigned to a syringe or syringes equivalent to the exact ordered amount. Please note, we do prepare and dispense a 2 mg syringe for morphine, but we are not currently doing this for oxycodone. Please let me know if you have any questions.