Parenteral morphine and oxycodone mixtures administered in specialised palliative and hospice care units: A...

Continuous subcutaneous infusions combining several drugs are routinely used in palliative care, particularly for severe pain management. Parenteral administration routes, however, have been found to be prone to errors. According to previous studies, standardising the compositions of parenteral mixtures can improve medication safety.

To evaluate the potential for standardisation of parenteral drug mixtures used in palliative and hospice care by identifying the most commonly administered compositions of mixtures containing morphine or oxycodone.

A retrospective medical record review of parenteral drug mixture administrations containing morphine or oxycodone.

Drug administration records of 120 deceased patients treated in two inpatient units and in the At-home hospital providing palliative and hospice care in the City of Helsinki, Finland, were collected. The data were analysed with descriptive statistics.

The patients (n = 120) received a total of 329 parenteral morphine or oxycodone containing drug mixtures administered as continuous subcutaneous infusions during a 10-month period from 28 April 2022 to 28 February 2023. Altogether, 29 different drug combinations were administered, of which the combinations of haloperidol and midazolam admixed with either morphine or oxycodone were the most prevalent ones (26.4% and 21.9% of all administrations, respectively). Of the 329 administrations, 175 different compositions were identified. In some of the mixtures, an increase in opioid quantity correlated with an increase in the other component quantities.

Although palliative and hospice care patients need individualised medications, standardisation might be possible for the morphine-based drug mixtures and for the mixtures containing midazolam and haloperidol admixed with morphine or oxycodone.