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INTERNAL ONLY
STANDING ORDER
EMERGENCY DEPARTMENTS
OXYCODONE HYDROCHLORIDE –
Oral administration by Accredited Emergency
Nurses for moderate to severe pain
POLICY STATEMENT
This order may only be activated under the specific circumstances set out in the section
“Indications” and provided there are no contraindications present.
The administering nurse must be accredited to administer the drug and record the
administration in ink on the once only section of the medication chart. This order must be
checked and signed by a medical officer within 24 hours, and preferably within 4
hours, of activation of the standing order.
This standing order is only valid until the date noted by the Drug and Quality Use of
Medicines Committee under the heading "Effective To:" at the end of this document.
1.
NURSING ACCREDITATION REQUIREMENTS
Accredited Registered Nurses employed within SESLHD Emergency Departments (ED) who are
working in a extended practice nurse or Advanced Clinical Nurse (ACN) capacity must have at
least a minimum of two (2) years emergency / critical care experience and must be able to work at
a minimum of resuscitation level or above (i.e. triage / clinical initiatives nurse) and/or as approved
by the ED Nurse Manager.
2.
INDICATIONS
Adult patients (16 years of age and over) able to tolerate oral medications who present to SESLHD
Emergency Department (ED) in moderate to severe pain with verbal numerical rating scale of
greater than three (3) and less than seven (7).
CONTRAINDICATIONS 1
3.
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Less than16 years of age
Haemodynamically unstable (meets PACE / Between The Flag criteria2)
Hypersensitivity to opiate narcotics
Acute respiratory depression
Cor pulmonale
Cardiac arrhythmias
Bronchial asthma
Acute alcoholism
Brain tumour
Head injuries
Increased cerebrospinal or intracranial pressure
Severe CNS depression
Convulsive disorders
Delirium tremens
Suspected surgical abdomen
Concomitant MAOIs or within 14 days of such therapy
REV 2
October 2014
Page 1 of 4
INTERNAL ONLY
STANDING ORDER
EMERGENCY DEPARTMENTS
OXYCODONE HYDROCHLORIDE –
Oral administration by Accredited Emergency
Nurses for moderate to severe pain
PRECAUTIONS 1
4.
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Impaired hepatic or renal function - the plasma concentration of oxycodone may be
increased in patients with hepatic or renal impairment. Therefore, dosage in such patients
should be reduced and adjusted according to the clinical situation.
Use in the elderly - oxycodone should be administered with caution, and in reduced dosages,
to elderly or debilitated patients.
Use in pregnancy (Category C) - opioid analgesics cross the placenta. The use of oxycodone
during labour may cause respiratory depression in the newborn infant. Babies born to opioid
dependent mothers may be physically dependent and suffer withdrawal symptoms
(convulsions, irritability, excessive crying, tremors, hyperactive reflexes, fever, vomiting,
diarrhoea, sneezing and yawning).
Use in lactation - oxycodone is excreted into human milk in low concentrations. Because of
the possibility of adverse effects in breastfed infants (sedation, respiratory depression,
withdrawal symptoms upon cessation of maternal administration), oxycodone is not
recommended for breastfeeding mothers unless the expected benefits outweigh the potential
risk.
5.
ACTIONS/MONITORING REQUIRED
Pre administration:
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Assessment of previous pain treatments utilised i.e. over the counter and/or prescription
drugs (previous opioid exposure)
A full set of vitals (heart rate, blood pressure, respiration rate, temperature, Glascow Coma
Scale (GCS) and pain score) must be taken prior to administration of oxycodone
hydrochloride.
Documentation:

Document patient observations including the patient’s pain score on the ED Standard Adult
General Observation (SAGO) Chart and/or electronically within Firstnet.
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The administering nurse must record the administration in ink on the ‘once-only’ section of
the National Inpatient Medication Chart (NIMC) as Emergency Department Standing Order
(i.e. “ED SO”) plus print and sign their name.
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The EDSO drug order must be countersigned by the medical officer that subsequently
assesses and treats the patient within 4 hours.
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Accountable Drug Register documentation must be completed i.e. when documenting in the
S8 drug book, the ED Medical Director’s name followed by ‘EDSO’ next to it to indicate this
is a standing order.
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The signatures of the administering nurse and nurse checking the medication must be
clearly documented both in the Accountable Drug Register and on the NIMC and includes
completing the date, time, drug, dose, route and time of administration sections.
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The administering nurse must record in the patient’s progress notes the administration and
effect of the medication.
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Drugs must be checked and ordered according to hospital policy and adhering to the
Ministry of Health Policy Medication Handling in NSW Public Health Facilities PD2013_043.
REV 2
October 2014
Page 2 of 4
INTERNAL ONLY
STANDING ORDER
EMERGENCY DEPARTMENTS
OXYCODONE HYDROCHLORIDE –
Oral administration by Accredited Emergency
Nurses for moderate to severe pain
Post administration:
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Evaluate and document therapeutic response to pain via numerical or visual analogue pain
score
Re-assessment of pain within one hour of administration
Monitor respiratory rate
Senior medical review must be obtained if any of the following occur:
1. Respiratory rate less than 10 breaths a minute
2. SpO2 <92%
3. Systolic blood pressure <100mmHg
4. Heart rate <50bpm
5. GCS < 14
6. Sedation score >1
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Notify a medical officer if patient meets PACE / Between The Flag criteria2 or
contraindications
Monitor for side effects and consider anti-emetics if nausea / vomiting develops.
Sedation scoring
Measuring patient sedation in relation to the medication discussed within the document, the
following tool is to be used:
0
1
2
Wide awake
Easy to rouse
Constantly drowsy, unable to stay awake
3
Yellow Zone: Cease administration. Given high-flow oxygen, complete primary survey, alert
attending emergency medical officer. If patient respiratory rate less than or equal to 5
breathes per minute, activate emergency call buzzer.
Difficult to rouse or unresponsive
Red Zone: Activate emergency call buzzer, complete primary survey, administer high-flow
oxygen.
6.
PROTOCOL/ADMINISTRATION GUIDELINES:
Caution: CHECK for allergies and/or contraindications and previous analgesia given
Drug
Oxycodone
hydrochloride
(immediate
release tablet)
Dose
Route
Frequency
Oral
Once only
16 to 65 years:
5 mg to 10 mg
over 65 years:
2.5 mg to 5 mg
Administer medication as per dosage with a sip of water
REV 2
October 2014
Page 3 of 4
INTERNAL ONLY
STANDING ORDER
EMERGENCY DEPARTMENTS
OXYCODONE HYDROCHLORIDE –
Oral administration by Accredited Emergency
Nurses for moderate to severe pain
7.
POTENTIAL ADVERSE EFFECTS/INTERACTIONS:
Most common side effects:
 Nausea, vomiting, constipation, drowsiness, unusual tiredness or weakness, vertigo,
faintness, lightheadedness, orthostatic hypotension and confusion.
Less frequent side effects:
 Dry mouth, sweating, facial flushing, nervousness or restlessness, difficult micturition
and/or antidiuretic effect. Raised intracranial pressure occurs in some patients.
Uncommon side effects:
 Bradycardia, supraventricular tachycardia, palpitations, anorexia, changes of mood,
respiratory depression and hallucinations have been reported.
 CNS stimulation, paradoxical and convulsions may occur especially in children.
Interactions:
 Anticholinergics increase risk of constipation or urinary retention
 Antihypertensive agents and CNS depressants are potentiated
 Effect of metoclopramide is antagonised
 Neuromuscular agents and coumarin anticoagulants are potentiated
8.
REFERENCES:
1. MIMMS Online. Oxycodone Hydrochloride. 2014 [cited 2014 25/8/14] Available from:
https://www.mimsonline.com.au.acs.hcn.com.au/Search/FullPI.aspx?ModuleName=Produc
tInfo&searchKeyword=oxycodone+hydrochloride&PreviousPage=~/Search/QuickSearch.as
px&SearchType=&ID=3670001_2
2. SESLHD Patient with Acute Condition for Escalation (PACE): Management of the
Deteriorating Adult and Maternity Inpatient SESLHD/PR283.
http://www.seslhd.health.nsw.gov.au/Policies_Procedures_Guidelines/Clinical/Other/SESL
HDPR283-PACE-MgtOfTheDeterioratingAdultMaternityInpatient.pdf
3. Ministry of Health Policy Medication Handling in NSW Public Health Facilities PD2013_043
http://www0.health.nsw.gov.au/policies/pd/2013/pdf/PD2013_043.pdf
Authorised by:
Name
Designation
Professor
Gordian Fulde
Emergency/ Critical
Care Stream Director
Endorsed by:
Name
Designation
Signature
Signature
Chair, SESLHD
D&QUM Committee
REV 2
Date
Endorsed
Date
Effective To:
30 November
2015
October 2014
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