3PC-032 Optimising analgosedation in the intensive care unit during the SARS-CoV-2 pandemic

Abstract

Background and importanceThe pandemic caused by SARS-CoV-2 evidenced the need for expediting the dispensation and usage process, poorly automated, of narcotic drugs and for optimising the most commonly used perfusions available in the hospital (midazolam, dexmedethomidine, propofol, fentanyl). With this intervention, significant improvements in efficacy and safety were expected, considering the fact that perfusions decrease the risk of infection, medication errors and the workload and exposure of nurses.Aim and objectivesTo elaborate a physicochemical and microbiological stable fentanyl perfusion and to adapt the presentations of drugs (midazolam, dexmedethomidine, propofol, fentanyl) used for analgosedation in COVID-19 patients admitted to the intensive care unit (ICU).Material and methodsA multidisciplinary team formed by intensive care doctors, nurses and clinical pharmacists was created in October 2020 to discuss areas of improvement and effort optimisation.All midazolam and propofol presentations were changed for others of larger volume available on the market. A dexmedethomidine perfusion 2000 mg/250 mL was standardised thanks to previous stability data collected.A new fentanyl perfusion was prepared and validated in sterile conditions after a literature systematic review, microbiological controls in tryptic soy broth (TSB) and thioglycollate broth, and a microbiological risk matrix were done.Fentanyl perfusions were stocked in Pharmacy and individually dispensed according to the infusion speed of each patient. Control numbers were assigned to every preparation to maintain the narcotics’ traceability.ResultsEach perfusion consisted of 1500 μg fentanyl (10 vials 150 μg/3 ml=1 perfusion) diluted in 100 mL sodium chloride 0.9%. The final stability given was 30 days at room temperature (all culture replicates in TSB and thioglycollate broth at days 0, 9 and 30 were negative). The daily number of preparations depended on the epidemiology of the disease. However, a median value of 13 perfusions was dispensed up to a total of 21 ICU beds.Conclusion and relevanceThis model can be extrapolated to other Pharmacy Services as long as volumetric pumps, trained professionals and horizontal laminar flow cabinets are available. The intervention met some of the demands created during the pandemic and helped to slightly attenuate the pressure on healthcare professionals.References and/or acknowledgementsConflict of interestNo conflict of interest