Morphine PCA Vials Shortage

• • Hospira has morphine PCA vials on shortage due to quality assurance issues.[1]

• • Morphine injection, Pfizer, 1 mg/mL, 30 mL PCA vial, 25 count, NDC 00409-2029-02
  • Morphine injection, Pfizer, 5 mg/mL, 30 mL PCA vial, 25 count, NDC 00409-6028-04

Estimated Resupply Dates

• • Hospira has morphine 1 mg/mL 30 mL and 5 mg/mL 30 mL PCA vials available.[1]

Implications for Patient Care

• • Morphine sulfate is an opiate agonist labeled for analgesia.[2] Hospira's preservative-free morphine sulfate PCA vials are for use only with a compatible Hospira PCA pump set, injector and infusion device.[2]

Safety

• • Use extreme vigilance when switching between different formulations of morphine sulfate and when switching to alternative opioid agonists. Patient harm can occur if these agents are dosed erroneously.[3] Use extra caution not to confuse these agents.[3]
  • No other opioid agonist can be substituted for morphine on a mg-per-mg basis.[4]

Alternative Agents & Management

• • Hospitals using Hospira's PCA pump set, injector and infusion device should conserve current morphine PCA supplies. Carefully determine each patient's need for morphine PCA.
  • For hospitals using Hospira PCA pumps, there is a shortage of empty PCA vials and injectors, thus limiting the possibility of preparing a morphine PCA.
  • The 2012 ASA Practice Guidelines for Acute Pain Management in the Perioperative Setting state there are equivocal findings regarding the analgesic efficacy of intravenous PCA opioid analgesics compared to nurse administered intravenous opioid analgesics.[5] Additionally, intramuscular opioids ordered on an as-needed basis are not a preferred route of administration.[5]
  • Use multimodal pain management whenever possible.[6]
  • Utilize stakeholder clinicians to help make plans for specific patient populations.

References

• 1. Hospira (personal communications and website). December 10 and 11, 2015; January 13 and 26, April 25, June 8, July 21, and August 1, 2016.
  2. Morphine Sulfate Preservative-Free Injection [product information]. Lake Forest, IL: Hospira; 2006.
  3. Institute for Safe Medication Practices. A Shortage Of Everything Except Errors: Harms Associated with Drug Shortages. Acute Care ISMP Medication Safety Alert. April 19, 2012.
  4. Momeni M, Crucitti M, De Kock M. Patient controlled analgesia in the management of postoperative pain. Drugs 2006; 66(18):2321-2337.
  5. American Society of Anesthesiologists Task Force on Acute Pain Management : Practice guidelines for acute pain management in the perioperative setting. Anesthesiology 2012; 116: 248-273
  6. Dickerson DM. Acute Pain Management. Anesthesiology Clinics 2014;32(2): 495-504.