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e20729 Background: Approximately 70 to 80% of all cancer patients receiving chemotherapy experience emesis and 10 to 44% experience anticipatory emesis. Aprepitant a neurokinin 1 (NK 1) receptor antagonist is used in chemotherapy induced nausea and vomiting. The present study was undertaken to assess efficacy, safety, and tolerability of Aprepitant in adult patients with chemotherapy induced nausea and vomiting. Methods: The study was conducted as a prospective, multicenter, randomized, open label, single group, phase III study in adult patients with chemotherapy induced nausea and vomiting and patients admitted to hospital for any type of cancer. The final protocol was approved by the Institutional ethics committee before the initiation of the study. Informed consent was obtained from all the patients before enrollment in the study. Aprepitant capsules were given in the dose of 125mg orally one hour prior to chemotherapy on day 1 followed by 80 mg orally in the morning on days 2 & 3.Aprepitant was combined with oral Dexamethasone 12mg oral 30 minutes prior to chemotherapy on day one and 8mg on the following two days. Efficacy of aprepitant was evaluated through number of emetic episodes within 24 hours or requirement for the rescue medication. Self assessment of nausea was done by patients using a 100 mm visual analog scale. Safety and tolerability was assessed through monitoring of adverse events and physical examination. Results: A total 30 patients (13 males) (mean age 40.45 years) were enrolled in the study. Significant (p<0.05)changes in emetic episodes were seen after treatment with aprepitant. Overall global assessment of vomiting indicated that 19 patients (82.6 %) had very good improvement, 3 patients (13%) had good improvement and one patient (4.4%) showed fair improvement after treatment with aprepitant. The most common adverse events included fever, headache, diarrhoea skin rash, constipation, and blisters. Severity of adverse events was mild to moderate and the adverse events disappeared with continued therapy. Conclusions: Treatment with aprepitant is a useful therapeutic option for the management of chemotherapy induced nausea and vomiting. [Table: see text]

BackgroundThe process of prescribing and preparing premedication for intubation needs to be completed carefully to ensure the correct dose is prescribed and administered. Doses of atropine, suxamethonium and fentanyl were banded according to weight. The dose banding was implemented alongside pharmacy prepared neonatal intubation drug kits and a prescribing bundle on the neonatal electronic prescribing system, which automatically populates the doses according to the patient’s weight.AimTo evaluate the safety of dose banding neonatal premedication for intubation.MethodsA tool was developed to collect data including the patient’s weight, gestation, if dose banding had been used and whether any adverse effects were experienced with emphasis on hypotension, bradycardia, chest wall rigidity and prolonged paralysis. Data was collected from January 2018 to July 2018.ResultsOutcomes from 89 intubations using dose banding were reviewed. The corrected gestation of patients (n = 63) were 24+3 to 42+1 and the weight from 500 g to 4 kg. In 97.75% all three pre-medication drugs were given, the 2 cases that did not were due to rapid desaturations and the decision was made to intubate before all the medicines had been administered. All cases used the correct dose-banding for the medication. In all cases the fentanyl was administered over at least 1 minute with 7.87% receiving the fentanyl over more than 2 minutes. 95.5% of patients were normotensive within 30 minutes of intubation. Hypotension was observed in 2 cases >90 minutes post intubation. In two patients, a low mean blood pressure (BP) was observed prior to the decision to intubate and the premedication did not cause a further decrease in BP. No patients experienced bradycardia, chest wall rigidity or prolonged paralysis.ConclusionThis work has illustrated that dose-banding of intubation premedication is safe in this cohort of neonates and allows for successful intubation, whether the patient is 24 weeks or 42 weeks corrected gestational age. Chest wall rigidity may occur if fentanyl is administered too quickly. All patients received fentanyl over at least 1 minute, with the majority receiving over 1–2 minutes. The fentanyl dose is a very small volume, to ensure the dose was administered slowly, a flush was used to ensure that any remaining in the cannula was not bolused to the patient. Hypotension was seen in 2 patients >90 minutes after intubation which is unlikely to have been related to the use of neonatal intubation drugs. However this highlighted that not all patients are having BP monitoring 30 minutes post-intubation. An outcome has been to emphasise the need for this monitoring. Bradycardia and prolonged paralysis, two potentially prominent adverse effects, were not seen indicating that the atropine and suxamethonium doses were appropriate. A limitation of this study was that patients concurrent medication was not recorded. Data will continue to be collected to assess safety as this data set did not include babies in the <500 g banding. The next step will be to com...

BackgroundIn January 2018, neonatal intubation premedication kits containing atropine, suxamethonium and fentanyl were introduced alongside the implementation of dose- banding for these medicines according to patient’s weight and regardless of the patient’s gestation. A prescribing bundle on the electronic prescribing system was also created to automatically populate the doses based on the patient’s weight. Seven kits are produced each week by the Pharmacy Technical Services Unit.AimTo assess the staff perceived impact of pre-prepared intubation drug kits with associated dose-banding of the medication.MethodsThree months after the kits were implemented, a survey was sent to all nursing and medical staff to establish their thoughts on the intubation process before and after the introduction of pre-made intubation drug kits.Results78 staff responded, 45.5% were doctors and 54.5% were nursing staff. The response rate was 53.8%. 78% of respondents reported being part of a difficult intubation over the last 5 years. The main problems identified, prior to the implementation of the neonatal intubation drug kits, included the intubation process (51.5%), preparation and communication prior to intubation, (13.6%), time drawing up intubation drugs (10.6%) and the patient having a difficult airway (9%). 87.2% found the premade intubation kits very useful, none of the respondents thought the kits were not useful. Four themes were found irrespective of whether the respondent was a doctor or member of nursing staff. The themes were: they made the process easier; quicker; reduced risk of error and helped provide better patient care. When asked if any complications had arisen, 4% reported that they had run out of kits and 2.7% said there was confusion when signing the kits out of the controlled drug (CD) register.Three weeks out of 25 saw all the kits being used, average usage is 4 intubation kits per week. 97.4% reported the doses used were effective in sedating and paralysing the baby prior to intubation, 2.6% commented that they were somewhat effective but that in one occasion the paralysis had not been optimal, however they questioned whether the cannula had been functioning properly.ConclusionThe implementation of ready to use intubation drug kits has made the process of preparing for an intubation easier and quicker for all involved in the process. Having the dose banding set up on the electronic prescribing system has reduced the chance of prescribing errors and the pre- filled kits have reduced the chances of calculation errors during drug preparation. When the kits run out there are instructions in the guideline detailing how to make the required concentrations. As a result of this study standardised teaching videos were introduced from the beginning of July 18. Further simulations have been completed to ensure that all staff follow a standardised process. Next steps are to ensure that the documentation in the CD register includes all necessary information without any need for amendments. To overcome this, a stamp is bein...