Pre-packed Critical Care Drug Pouch for Acute Patient Care: Consensus, Simulation Testing and Recommendations

Emergency and sedation drugs availabilityand preparation represent a challenge in thesetting of acute care or resuscitation outsidethe intensive care unit [ICU] (Glavin 2010;Sakaguchi et al. 2008) (Figure 1). Websteret al (2001) identified an error rate as highas 1 in 133 routine anaesthetics with rootcauses being syringe swaps (20%) andincorrect doses due to human errors (20%).More stressful environments such as theacute care settings have an even greater riskof preventable errors (i.e. avoidable by anymeans currently available), reaching 30%(Wilmer et al. 2010).On the contrary, Highly Reliable Organisations(HROs) have the capacity to operatein hazardous situations with consistent,effective, nearly failure free performance,whilst maintaining optimum output (Roberts1990; La Porte 1996). HROs encourage theuse of checklists and pre-packed equipmentto reduce variability and errors caused byhuman factors. There is substantial materialpublished about the ideal content of cardiacarrest trolleys, difficult airway trolleys, andtransfer equipment bags (Henderson et al.2004). Unfortunately, there is little in theliterature about the drugs available anddesirable during a critical care transfer oremergency intubations outside the ICU. Theaim of this project is to illustrate the processused for defining the content through toimplementation of a critical care pre-packedresuscitation pouch (CCP).