Download Diamorphine Injectio

DiamorphineHCl Injection
Staff Characteristics
Clinical Details
Registered Midwife
Clinical Situation for which
medicine is to be used
Pain relief for women in established labour after assessing the level of
pain.
Clinical Criteria for inclusion
Women ≥ 16 years in established labour requesting pharmacological
analgesia.
Clinical Criteria for exclusion
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Management of excluded women
and those not wishing to receive
care
Use in pregnancy or lactation
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Women who have already received another opioid
Known hypersensitivity to any component of the medicine.
Individuals < 16 years of age
Woman with booking weight < 50Kg.
Hypersensitivity to Diamorphine or Morphine.
Respiratory depression, obstructive airways disease,
eclampsia, phaeochromcytoma, hepatic impairment, drug
dependence, renal impairment, coma, raised intracranial
pressure, biliary colic.
Women receiving monamine oxidase inhibitors (e.g.
phenelzine, moclobemide) or within two weeks following their
withdrawal.
Refer to medical staff as appropriate.
Document action / refusal in woman’s maternity handheld
record.
In Pregnancy
Administration during labour may cause respiratory depression in the
neonate and gastric stasis during labour, increasing the risk of
inhalation pneumonia.
In Lactation
Diamorphine should not be given to women who are breastfeeding as
there is limited information available on diamorphine in breast milk.
Cautions and/or reasons for
seeking further advice from a
doctor
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If woman experiencing insufficient pain relief.
Woman fits exclusion criteria.
Woman suffers an adverse drug reaction.
Chronic dosing is required.
Woman declines medication.
Cautions and action that will be
taken if a caution applies
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Check for and document any allergies.
Check and document past medical and drug history and current
medication to ascertain potential for overdose.
If a caution applies consult with medical staff.
Document consultation in woman’s maternity handheld record.
Refer to current BNF for latest information on interactions.
Hypotension.
Hypothyroidism
Asthma (consult with medical staff re:dosage as may need
reduced).
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Hepatic impairment.
Renal impairment (consult with medical staff re:dosage as may
need reduced).
Acute alcoholism.
Description of Treatment
Name / Form / Strength of
Medicine
DiamorphineHCl / Powder for Injection / 5mg
Dosage
Dose according to local Trust guidelines.
Route of administration
Intramuscular
Frequency of administration
According to local Trust guidelines.
Duration of treatment
Duration of labour
Legal Status
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POMCD – midwife may administer as medicine is on midwives
exemption list.
Storage requirements
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Store in Controlled Drug Cupboard.
Do not store above 25°C.
Keep container in the outer carton.
Warnings
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A Controlled Drug may not be administered by a student
midwife under a midwife exemption.
The woman should be checked for excess sedation and for
signs of respiratory depression.
The drug may cross the placenta and cause neonatal
respiratory depression.
Caution should be exercised in women with a known history of
drug abuse.
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Follow –up
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Undesirable effects
Refer if woman develops side/adverse effects or if there is an
inadequate response.
Refer immediately in case of overdose.
The most serious hazard of therapy is respiratory depression although
circulatory depression is also possible. The most common side effects
are sedation, nausea and vomiting, constipation and sweating.
Other side effects include dizziness, miosis, confusion, urinary
retention, biliary spasm, orthostatic hypotension, facial flushing, vertigo,
palpitations, mood changes, dry mouth, dependence, urticarial, pruritus
and raised intracranial pressure.
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If a serious adverse reaction is suspected please report to the
MHRA Yellow Card Scheme http://yellowcard.mhra.gov.uk/
Overdose
The triad of respiratory depression, coma and constricted pupils is
considered indicative of opioid overdosage with dilatation of the pupils
occurring as hypoxia develops.
• Immediate assessment / treatment is essential – refer to
medical staff
• Manage in accordance with established treatment guidelines or
see BNF overdose section
• For further advice contact National Poisons Centres
0844 892 0111
Advice to be given to the woman
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Explain treatment and course of action.
Side effects explained.
Verbal consent obtained before administration.
It is good practice to offer the woman the manufacturer’s
Patient Information Leaflet to support any verbal advice
provided.
Monitoring arrangements during
and after treatment and follow-up
required.
Once diamorphine has been administered, the following should be
assessed and documented in case notes at 15 minutes intervals until
and thereafter for the next 4 hours unless in established labour when
observation should be continued as per local Trust guidelines.
• Contractions (length, strength, and frequency).
• PV loss.
• Fetalheart rate.
• Effectiveness of diamorphine.
• If thewoman suffers a serious adverse drug reaction, seek
immediate medical assistance.
• Monitor for side effects and effectiveness.
• To be reviewed by doctor if inadequate response.
Records to be kept
Must be written in the once only medicines and pre-medications
section of the medicine kardex. The person who writes up the
medication must write their designation after their signature e.g.
Midwife Band (*). Also record the administration, date, time and name
of practitioner in the relevant section of the woman’s maternity
handheld record.
References
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Diamorphine SPC Wockhardt UK Ltd 31st August 2007
www.medicines.org.uk
Guideline for administration of diamorphine as analgesia in
labour. Integrated Maternity & Women’s Health Division
Guideline Committee Southern Health & Social Care Trust
October 2010.