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