Fanny Li, BCPS, PharmD
Critical Care Pharmacy Supervisor
University of California San Francisco Medical Center
San Francisco, California
Disclosure information not submitted.
Kenneth Tham, PharmD
Clinical Pharmacist, General Oncology
Seattle Cancer Care Alliance, United States
Disclosure information not submitted.
Joanne Smith, PharmD, BCCCP
Critical Care Pharmacist
Centura Health St. Anthony Hospital, United States
Disclosure information not submitted.
Title: Rapid Sequence Intubation Medication Panel; Optimizing Workflow and Safety
Introduction/Hypothesis: Rapid sequence intubation (RSI) is an urgent procedure involving high-risk medications, such as paralytics. Barriers in medication prescribing, review, and verification may result in delays and an increase in medication overrides from automated medication dispensing machine (Pyxis™), bypassing the 5 rights of medication administration. Additionally, given the urgent nature of workflow, medication administrations may not be recorded in the medication administration record (MAR).
Methods: At a tertiary teaching medical institution, an interdisciplinary team of providers, nurses, and pharmacists developed an Adult Intubation Medication Order Panel to facilitate faster and safer workflow. The panel has: 1) a defined duration of therapy (one-time doses expire in 24hrs and continuous IV infusions expire in 4hrs), 2) standardized medication formulation and concentrations of RSI meds already loaded in the pyxis or intensive care unit (ICU) anesthesia bag, and 3) STAT order priority to facilitate faster order verification and medication access. A retrospective review of monthly data evaluated the impact and accuracy of this workflow pre and post medication order panel implementation.
Results: Comparing the pre-implementation group (n=35) vs post-implementation group (n=25), the rates of Pyxis™ override decrease from 53% to 35%, p=0.016. There was also a decrease to time to order verification by an average of 12.5 mins (19.8 mins pre vs. 7.3 mins post). Overall, medication reconciliation increased between provider note and MAR by 6% (76/100 [76%] pre vs 53/65 [82%] post). In the post-implementation group, the medication panel was used in 40% of all intubations.
Conclusions: An Adult Intubation Medication Panel facilitated safer medication workflow but there can be improvement in medication reconciliation between provider note and MAR to improve transparency of what and when high risk medications were given. Next steps include integration of panel into provider note and billing to best enable the integrity of this urgent and stressful workflow.