Covid-19: Clinical strategies and medication safety in critical care

By Rhona Sloss, Specialist Pharmacist Critical Care and Reena Mehta, Pharmacy Team Leader Critical Care, King’s College Hospital NHS Foundation Trust

Rhona Sloss (left) and Reena Mehta (right)

As part of the King’s Critical Care Team, we have had to respond quickly to a rapidly changing Covid-19 situation, after receiving our first patient on Friday 6th of March.

Over the last three weeks, we have been faced with new challenges on an hourly basis, as we prepare to increase our critical care bed capacity by 380% across two sites. While this brings several operational and logistical challenges, it is also important to prioritise appropriate clinical strategies and medication safety considerations to ensure patient safety is not compromised.

With a variety of consultants from different specialities caring for patients, as well as junior doctors with no prior critical care experience, some consistency in our clinical approach is required. Based on the recognisable pattern of how Covid-positive patients present, we have created an “admission prescribing order set” to ensure key drugs are prescribed quickly and accurately. We have focused on streamlining sedation strategies by devising a flow sheet to guide the choice of appropriate agents, giving options of alternatives if supply of first line drugs becomes difficult. To help with prescribing and administration, all areas have implemented a pre-printed infusion prescription chart. These interventions are necessary in order to ensure patients can be managed safely.

The increasing demand and workload placed on our critical care nurses over the past three weeks has also been evident. As nurse-to-patient ratios increase, it is important as pharmacists to consider reviewing the various medicines management policies and seek opportunities to make safe changes which can help during this period. This may include single nurse checking of injectables (with some exceptions) and reviewing storage of medicines at the bedside where POD lockers may not be available.

Considering strategies to reduce the burden on nurses of continually drawing up multiple infusions is also vital. Ideas we have considered include giving medications as intermittent boluses instead of infusions, using more concentrated solutions and looking at options to source pre-filled syringes, including exploring an in-house CIVAS service.

As pressure on us all undoubtedly increases in the coming weeks, the crucial role of clinical pharmacists will be more vital than ever. As we continue to learn on a daily basis and deal with new challenges, the value of communicating with each other, both locally and nationally, has never been more important.

Critical care pharmacy during the COVID-19 pandemic

Sinéad O’Halloran, Consultant Pharmacist Critical Care

by Sinéad O’Halloran, Consultant Pharmacist Critical Care, Lewisham & Greenwich NHS Trust

The first critical care COVID 19 patient arrived on our ward on 7th March. By Monday 23rd March we had more than double the usual number of ventilated patients at both of our hospitals. There seems to be a clearly recognisable pattern, patients in their 50s and 60s with single organ failure, presenting with a history of fever, and flu like symptoms. Patients are acutely hypoxaemic, and many required proning. On critical care, side rooms and negative pressure rooms quickly became full and ventilated patients were then cohorted in open ward areas. All staff entering COVID areas require varying degrees of PPE and this has been also been an area of challenge. 

Read more Critical care pharmacy during the COVID-19 pandemic

Social media – let’s make it a force for good.

Social media use is always under scrutiny.

Whether it’s the amount of screen time children should have or whether vloggers should be encouraging gambling, the public’s mood seems to be in favour of more regulation, accountability and transparency.

We are fast approaching the 2020 RPS elections! We want everyone to enjoy the experience of being part of the elections, whether as a candidate or as voter, so we will do our best to encourage friendly and professional discussion.

We’ll be encouraging members standing for election to campaign via social media, online forums and blogs. We know this is a great way to reach and engage with voters. If you’re standing for election this year, we will send you specific guidance to help.

The best advice I’ve ever received about testing whether something is suitable to be shared on social media or not is: “If you wouldn’t say it in the ‘real world’, don’t say it in the ‘digital world’.

We love a robust but polite debate. Read more Social media – let’s make it a force for good.

How to get the most out of a mentoring relationship

By Helen Middleton, MSc (Education), FFRPS, FPharmS

Mentoring can provide opportunities for both mentors and mentees to progress. Read on to find out how to make this relationship work…

Mentoring will have a different meaning for different individuals. For some it will mean a relationship where the mentor guides the mentee on specific topics; for others it will relate to a wider, less directive relationship.

Match expectations

If there is a mismatch of the expectations of the mentor with those of the mentee, the mentoring relationship could be destined for failure. Therefore, it is important to discuss expectations at the outset of any mentoring relationship.

The following questions can be asked by both the mentor and mentee to help decide whether or not they are a suitable match:

  • How would you define mentoring?
  • What do you want to get out of this mentoring process?
  • What do you expect from me?

It is unlikely that the expectations of each party will be identical, so some compromises may be necessary to find common ground. However, if the expectations of each party are quite different then it may be better for the mentee to look for an alternative mentor via the Royal Pharmaceutical Society mentoring platform.

Mentor versus manager?

Some managers think they can mentor individuals at the same time as managing them. This is not recommended because it can be difficult for a manager to balance his or her different roles.

A mentor should focus on:

  • Supporting long-term development for the mentee’s current and future roles
  • Helping the mentee reflect on his or her practice
  • Helping the mentee identify development opportunities and learning needs
  • Setting goals to learn, develop and progress
  • Helping the mentee to monitor his or her own development

In contrast, a manager will tend to focus on: completing tasks and meeting immediate deadlines; assessing performance against standards and carrying out appraisals; enabling the worker to deliver and perform; setting objectives and checking on progress; and monitoring performance to ensure quality.

In addition, managers can be tempted to be directive and give their own answers to the mentee’s problems. It can also be uncomfortable for an individual to discuss their weaknesses and issues in a full and open manner with their manager, particularly if the issues are contentious.

Supportive, not instructive

To be an effective mentor, it is not necessary to be especially senior within an organisation or to have specialist knowledge of the mentee’s area of practice. The mentor should be an enthusiastic “people developer” who facilitates problem solving and action planning.

Mentors need to stand back, be objective and non-judgemental, and be able to put themselves in the mentee’s position. Rather than acting as an expert, mentors take on a supportive role: encouraging mentees to find their own expertise. A mentor can be thought of as a catalyst that stimulates self-directed change, with a belief in the mentee’s ability to solve his or her own problems.

This piece is abridged from an article by Helen Middleton, MSc, MRPharmS, first published in Clinical Pharmacist (2011;3:345).

Sign up on www.rpharms.com/mentoring 

RPS mentoring platform facilitates easy and appropriate matching of mentor to mentee.