Paediatric Acute care Guidelines PMH Emergency Department


This protocol allows intravenous morphine to be administered by trained registered nurses in the Emergency Department when prescribed by ED medical staff


Staff Eligibility:

Eligible Staff:

  • Registered Nurses who are permanent staff or regularly employed in ED and who have completed a 3 month orientation to the PMH ED
  • All staff must complete the education package and be deemed competent by the CNM, CNS or CDN prior to commencement of administering Morphine under the protocol

Ineligible Staff:

  • Agency, new staff and relieving staff are not to administer IV Morphine in the ED



Patient Inclusion and Exclusion Criteria

Inclusion Criteria

  • Age > 6 months
  • Painful condition necessitating IV narcotic

Exclusion Criteria

  • Age < 6 months (mandates administration by a doctor using lower doses, carefully titrated)
  • Any concerns regarding airway anatomy or cardiovascular, neurological or other instability
  • Note:  Maximum respiratory depression occurs within 7-10 post IV administration and 20-30 minutes post IM administration.  Respiratory depression may occur late, after the painful stimulus is removed.





6  months and older  

  • 0.05mg/kg to a maximum dose of 2 mg
  • Maximum of 2 boluses at a 10 minutely interval can be given by the nurse
  • If additional doses are required, they should be administered by medical staff
  • Larger doses must be administered by medical staff



  • Doctor assesses the patient’s analgesia requirement, drug allergies, recent medication and suitability for IV Morphine
  • An IV cannula is inserted into the patient
  • Morphine is prescribed on the front of the YELLOW Medication Chart as IV Morphine Bolus ____mg/kg, Total Dose = ____mg 
  • Only one dose to be prescribed at a time on medication chart
  • Additional doses should be prescribed if/when required
  • Maximum number of boluses that can be administered by the nurse is 2 with a minimum of 10 minute  interval


  • Morphine is available as 10mg/ml.  Dilute 10mg of Morphine with 9 ml of 0.9% Normal Saline to make a solution of Morphine 1mg/ml
  • The calculated dose is administered over 2-3 minutes via a 3-way tap or injection port and is followed by a 0.9% Normal Saline flush
  • The Emergency Department Schedule 8 Register is completed by the staff member who administers the medication.  The staff member who checked the drug must countersign the register.


Considerations and Monitoring

  • Have knowledge of the medication including the side effects (most important are hypotension, respiratory depression), dosage and rate of administration
  • Ensure suction and oxygen are available, and emergency equipment of appropriate size 
  • Observations
    • Baseline observations: HR, BP, RR, oxygen requirement, conscious state and pain scores are recorded
    • Record HR, RR, oxygen saturation level and sedation score every 5 minutes for 15 minutes after each administration of Morphine
    • BP should be recorded if clinically indicated 
  • If pain relief is inadequate after 2 doses
    • < 2 hours since last dose administered – a doctor is required to administer subsequent IV analgesia
    • > 2 hours has passed, the doctor may prescribe a second ED IV Morphine protocol
  • Reversal Agent:
    • Naloxone is available in the Resus Room
    • Should be administered for excess sedation or respiratory depression
    • For excess sedation/respiratory depression:  Dose – 1-5 micrograms/kg  IV, maximum dose of 100 micrograms, may be repeated every 2-3 minutes if required
    • For resuscitation (minimal respiration, cardio respiratory arrest):  Dose 10 micrograms /kg (up to 400 micrograms), may be repeated every 2-3 minutes if required
    • Has short duration of action – approximately 30 minutes, may necessitate repeat doses or infusion


PMH ED Guideline: Morphine IV – Nurse Administration – Last Updated: October 2014
AMH Children’s Dosing Companion (online).  Adelaide:  Australian Medicines Handbook Pty Ltd; 2014 July.  Available from:



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