A 78-year-old opioid-naive client is admitted for a hip fracture and an order is received for morphine PCA: demand dose 1 mg, lockout 8 minutes, plus a continuous basal infusion of 1 mg per hour. Which is the priority nursing action before initiating?

Patient-controlled analgesia for opioid-naive adults follows the safety principle that the patient is the only one who should self-administer; sedation prevents further button presses and is the first-line guard against overdose. A continuous basal infusion bypasses this guard because dose continues regardless of patient state. ISMP and Joint Commission both caution against routine basal infusions in opioid-naive adults; basal infusions are reserved for patients with documented opioid tolerance, severe cancer pain, or end-of-life care, with extra monitoring and prescribed plans. Older adults are at particularly high risk because of altered pharmacokinetics, reduced renal/hepatic clearance, polypharmacy, and existing respiratory and cognitive vulnerabilities. Standard initiation in this patient: (1) hold the basal portion, contact the prescriber to clarify and request demand-only dosing initially with frequent reassessment; (2) ensure multimodal analgesia (acetaminophen scheduled, regional anesthesia or nerve block when available, ice/ice packs, position and physical therapy); (3) continuous SpO2 with capnography for high-risk patients; (4) frequent POSS, RR, and pain reassessment with two-nurse double check; (5) document and educate the patient and family. Starting as ordered, turning off oximetry, or doubling the demand dose are all unsafe; the basal must be addressed through the prescriber.

Basal infusion plus opioid-naive elderly is the textbook overdose recipe. Hold and clarify before starting; safer plan is demand-only with multimodal and capnography.