Morphine Bolus from Ampoule

Name:

NHI:

Wt (kg):

Morphine Bolus Dose

Affix Patient Identification Label Here

Name:

NHI:

Weight:

Request Summary:

Dose:

Step One:

Step Two:

Administration:

Warning:

Report Prepared:

Report Expires:

Prescribing NNS / Doctor:

Pt. Name NHI Weight Correct Medication Matches Prescription

NNS / Doctor Sign

Before giving:

Pt. Name NHI Weight Correct Medication Matches Prescription

Nurse-1 Sign

Before giving:

Pt. Name NHI Weight Correct Medication Matches Prescription

Nurse-2 Sign

For use only in conjunction with the CCDHB NICU drug monographs!

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