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.
From a medicines management point of view, the pharmacist’s role in the COVID19 pandemic is key. Maintenance of the drug supply to critical care is vital and the stock of vasoactive agents, sedatives, analgesics and paralysing agents need to be increased in line with rapidly increasing patient numbers. The pharmacy team must be aware of current patient numbers and of the target surge numbers, to ensure drug supplies are available to meet this demand. We are using drug usage calculators to anticipate demand and ensure that we are proactively ordering the amount that we will need. We have had discussions with the critical care consultants to identify second and third line agents that we could use if patient numbers increase significantly and we have difficulties getting hold of the first line drugs.
As with many hospitals, we are in the process of setting up relevant clinical trials. With the critical care doctors under enormous pressure, the pharmacy team are looking at enhanced ways in which we can support the implementation and ongoing management.
Given this expanding bed base, it is important to identify pharmacists with suitable skill sets, who can be quickly trained to cover critical care beds as the pandemic deepens. We are producing training material to upskill all of our pharmacists to be able to clinically screen prescriptions for critically ill patients being cared for in non-critical care areas and we have also ensured that all of our pharmacist independent prescribers have been registered under a generic scope of practice for adult inpatient prescribing, so that we are ready to support prescribing in any area as needed. EPMA has been invaluable during this time. If ever you were looking for justification to support electronic prescribing- this is it!
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