RPPEO has issued Medical Advisory MA-2026-01, “Preventing Patient-Safety Incidents Involving HYDROmorphone,” following patient-safety incidents involving medication selection and errors in calculating or preparing HYDROmorphone. 

The advisory introduces safeguards to support safer medication preparation and administration. Paramedics should read the medication name and concentration directly from the vial, complete a medication cross-check before preparing and administering HYDROmorphone, and resolve any discrepancy in the medication, concentration, dose, calculated volume or route before proceeding. 

As an additional system safeguard, affected Paramedic Services are transitioning from HYDROmorphone 10 mg/mL to 2 mg/mL. Services may transition at different times, making it particularly important for paramedics who work in more than one service to verify the concentration stocked rather than relying on familiarity with a particular vial, package or service. 

The Medical Advisory also reminds paramedics to consider the full range of analgesic options available under the applicable medical directive. An OMC Base Hospital Physician can provide additional support with dose and volume calculations when helpful. 

Read the Advisory and Supporting Resources 

• Medical Advisory MA-2026-01: Preventing Patient-Safety Incidents Involving HYDROmorphone 

• HYDROmorphone_Evidence_Based_Regional_Change.pdf

• HYDROmorphone_Safety_Considerations_for_Paramedics.pdf 

These resources are intended to be used together to support the regional transition and reinforce safe medication selection, preparation and administration. 

Paramedics are encouraged to continue reporting medication incidents, near misses, good catches and medication hazards through the RPPEO Patient Safety Incident Report. These reports help RPPEO and Paramedic Services identify opportunities to strengthen medication systems, education and patient care. 

Questions about the Medical Advisory can be directed to quality@RPPEO.ca or MedicLINE at 1-877-587-7736.