A pilot evaluation of a hydromorphone dose substitution policy and the effects on patient safety and pain management.

Hydromorphone is a potent opioid analgesic commonly utilized in the hospital setting for the management of acute pain. Initial dose recommendations range from 0.1 to 2 mg of hydromorphone for opioid-naïve patients. This creates a challenge to optimally dose hydromorphone in opioid-naïve patients with the goals of avoiding opioid toxicities while also providing adequate pain management. In order to minimize the incidence of opioid toxicity, a community hospital implemented a dose-substitution hydromorphone policy that allows practitioners to automatically use a lower dose of hydromorphone within criteria limits. This pilot study was conducted to assess if the implementation of a low-dose hydromorphone protocol reduces the incidence of opioid toxicity while maintaining adequate pain management. This retrospective, observational, single-center cohort study examined hospitalized patients treated with hydromorphone between January 2013 and November 2013. Inpatients over 18 years of age who received hydromorphone were included in the study. The primary outcome of the study was the incidence of opioid toxicity. The secondary outcome of the study was adequate pain management. The results of this study showed no difference in opioid toxicity; however, patients required less per day hydromorphone and other opioids while still adequately managing patients' pain.