Download standing orders

INTERNAL ONLY
STANDING ORDER
EMERGENCY DEPARTMENTS
METOCLOPRAMIDE HYDROCHLORIDE –
Administration by Accredited Emergency Nurses
for nausea and/or vomiting
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 (20 years of age and over) who present to SESLHD Emergency Department (ED) to
control nausea and/or vomiting.
CONTRAINDICATIONS 1
3.
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Less than 20 years of age
Haemodynamically unstable (meets PACE / Between The Flag criteria2)
Where gastrointestinal motility might be dangerous, e.g. in the presence of gastrointestinal
haemorrhage, mechanical obstruction or perforation.
Phaeochromocytoma.
Known hypersensitivity or intolerance to the drug.
Porphyria.
Epilepsy.
The patient is receiving other drugs which are likely to cause extrapyramidal reactions.
PRECAUTIONS 1
4.
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REV 1
Dystonic reactions- occur in approximately 1% of patients given metoclopramide.
Neuroleptic malignant syndrome- has been reported with metoclopramide.
Previously detected breast cancer
Monoamine oxidase inhibitor therapy within 14 days
October 2014
Page 1 of 4
INTERNAL ONLY
STANDING ORDER
EMERGENCY DEPARTMENTS
METOCLOPRAMIDE HYDROCHLORIDE –
Administration by Accredited Emergency Nurses
for nausea and/or vomiting



5.
Other- Special care should be taken in cases of severe renal insufficiency.
Metoclopramide should be used with caution in patients with hypertension as intravenously
administered metoclopramide has been shown to release catecholamines.
Metoclopramide can exacerbate parkinsonian symptoms, therefore it should be used with
caution, if at all, in patients with parkinsonian syndrome.
Use in pregnancy- (Category A)
Use in lactation- Adequate human data on use during lactation and adequate animal
reproduction studies are not available.
ACTIONS/MONITORING REQUIRED
Pre administration:
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Assessment of previous medications utilised i.e. over the counter and/or prescription drugs
A full set of vitals (heart rate, blood pressure, respiration rate, temperature) must be taken
prior to administration of metoclopramide hydrochloride
Documentation:

Document patient observations on the ED Standard Adult General Observation (SAGO)
Chart and/or electronically within Firstnet.

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.

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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The signatures of the administering nurse and nurse checking the medication must be
clearly documented 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.
Post administration:
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REV 1
Evaluate and document therapeutic response to the antiemetic.
Notify a medical officer if patient meets PACE / Between The Flag criteria2
Monitor for side effects and notify a medical officer if they occur
Warn patient not to drive or operate machinery (drowsiness and dizziness may occur)
October 2014
Page 2 of 4
INTERNAL ONLY
STANDING ORDER
EMERGENCY DEPARTMENTS
METOCLOPRAMIDE HYDROCHLORIDE –
Administration by Accredited Emergency Nurses
for nausea and/or vomiting
6.
PROTOCOL/ADMINISTRATION GUIDELINES:
Caution: CHECK for allergies and/or contraindications
Drug
Dose
10 mg*
Metoclopramide
hydrochloride
In severe renal
impairment:
5 mg
Route
Frequency
Oral
OR
Intramuscular
OR
Intravenous
Once only
Give oral tablet if tolerated.
Intravenous injection must be given slowly over 1 to 2 minutes
*Halve the dose in severe renal impairment (5 mg)
7.
POTENTIAL ADVERSE EFFECTS/INTERACTIONS:
Most common side effects:
 Restlessness, drowsiness, fatigue, and lassitude
Less frequent side effects:
 Insomnia, headache, dizziness, nausea, and bowel disturbances
Uncommon side effects:
 Acute depression, anxiety, and agitation.
 Acute dystonic reactions, neuroleptic malignant syndrome, hypersensitivity reactions,
urinary incontinence and frequency.
Interactions:
 Effects of metoclopramide are antagonised by anticholinergics and narcotic analgesics.
 Metoclopramide may alter absorption of other orally administered medicines.
 Altered food absorption may impact diabetic control
 Additive sedative or extrapyramidal effects
REV 1
October 2014
Page 3 of 4
INTERNAL ONLY
STANDING ORDER
EMERGENCY DEPARTMENTS
METOCLOPRAMIDE HYDROCHLORIDE –
Administration by Accredited Emergency Nurses
for nausea and/or vomiting
8.
REFERENCES:
1. MIMMS Online. Metoclopramide Hydrochloride. 2014 [cited 12/9/14] Available from:
https://www.mimsonline.com.au.acs.hcn.com.au/Search/FullPI.aspx?ModuleName=Produc
t%20Info&searchKeyword=maxolon&PreviousPage=~/Search/QuickSearch.aspx&SearchT
ype=&ID=5470003_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
Signature
Professor
Gordian Fulde
Emergency/ Critical
Care Stream Director
Date
Endorsed by:
Name
Designation
Signature
Chair, SESLHD
D&QUM Committee
REV 1
Date
Endorsed
Effective To:
30 November
2015
October 2014
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