Morphine Tapering Algorithm in Bmt Patients

Pederson, Carol

Abstract

The long-term objective of this quasi-experimental study is to promote optimal morphine tapering in bone marrow transplant (BMT) patients. This will be evidenced by a taper that is no longer than necessary to manage pain to patients satisfaction while remaining free of withdrawal symptoms, or having them managed quickly. A morphine taper that lasts no longer than necessary to adequately manage pain may allow patients' earlier resumption of self-care, independence, and earlier discharge from the BMT Unit, thus promoting cost effectiveness and conserving health care resources.
Specific Aim 1 and related questions address the exploratory aspect of the study.
Specific Aim 2 and related hypotheses address the quasi-experimental aspect of the study.
Aim 1 : Examine BMT nurses' current morphine tapering practice. Questions: A. How much variance is there in the rate and length of taper? B. To what extent do nurses document their rationale for adjustments in the rate of taper? C. What is the incidence, intensity, and duration of patient pain and withdrawal symptoms? Aim 2: Determine the effect of implementing an algorithm for BMT morphine tapering. Hypotheses: Use of the algorithm will: -not increase occurrences of self-reported withdrawal symptoms; -decrease the duration of self-reported withdrawal symptoms; -shorten the duration of morphine tapers; -increase nurses' documentation of withdrawal symptoms; -maintain a level of pain management that is satisfactory to patients. Methods include collecting data on identified variables from the first consecutive series of 30 adult subjects and 30 pediatric subjects, implementing the algorithm, then collecting data on the identical variables from the second consecutive series of 30 adult subjects and 30 pediatric subjects and testing the effect of the algorithm.