Distribute instructions for oral dispenser
From the April 2010 issue
Take a look at the oral dispenser that accompanies morphine sulfate concentrated oral solution 100 mg per 5 mL (see Figure 1). The dispensing end of the plunger is pointed rather than flat—a specialty design not typically employed by many US suppliers of oral syringes (e.g., Baxa, BD, B. Braun). It accompanies some liquid products from manufacturers for the purpose of providing a low residual syringe volume after drug delivery. The pointy tip fits into the hub area, pushing out liquid and leaving little behind in the dead space. However, confusion has been reported regarding how to measure liquids—from the end of the pointed tip of the plunger, or from the widest part of the plunger above the pointed tip. Some long-term care nurses have been using the pointed tip of the plunger to read the volume against the syringe scale, which is incorrect. All doses should be measured by aligning the widest part of the syringe plunger with the calibrated markings. By measuring from the tip, caregivers will administer more than the intended dose. A long-term care consultant pharmacist brought this issue to light when narcotic counts at three different facilities showed remaining volumes different than expected. Residents may have been given higher doses than prescribed if nurses measured the dose by aligning the plunger tip with the calibrated markings on the barrel. The error happened with a generic product, which is no longer on the market; however, Roxane distributes a morphine sulfate oral solution that uses the same syringe. The FDA-approved Medication Guide for the Roxane product has a section under “Patient Instructions for Use” that explains exactly how to use the syringe, and it has a detailed illustration showing how to accurately measure the product (see Figure 2 on page 1). Education of nurses, pharmacists, and other healthcare professionals may be necessary if the “Patient Instructions for Use” information is not reaching them. Please pass this information along whenever you dispense morphine 100 mg per 5 mL or any other product packaged with this type of syringe. The reporter suggested that the company include the syringe diagram on the box flap of the product’s carton; however, the carton may not always reach the caregiver. Syringe manufacturers should explore design improvements to reduce the risk of confusion. For example, one reviewer suggested manufacturers make the main shaft of the plunger black, like many other syringes, and the pointed tip translucent.