Royal Columbian Hospital Team

Airway management of COVID-19 patients poses unique challenges. For patients who require advanced airway management, a priority is to optimize intubation success. The aerosolizing nature of airway interventions confer additional risk to the health care team.

Through a multidisciplinary discussion, amongst pharmacy, emergency and anesthesiology, COVID intubation kits were created at the RCH emergency department to facilitate performing intubation with minimal delay and maximum safety. Guiding principles to create these kits were: 1) to minimize traffic of people into isolation rooms , 2) to align with best practice (optimize intubation success), 3) appropriate post-intubation care and 4) reduce drug wastage. The COVID intubation kits include medications, syringes, needles, IV line tubing, and medication labels – all the supplies required for intubation and post-intubation care for at least 1 hour to align with best aerosolized generating procedure practices. These kits are brought to all code blues in RCH and intubations for suspected/confirmed COVID.

Challenges with creating these kits involved 1) contents – what is absolutely necessary to include and in what quantities 2) stability and storage (eg. rocuronium requires refrigeration) 3) managing returns and minimizing wastage – as not all the contents are used in the kits each time, 4) awareness and education of kits and 5) operationalization of kit assembly by pharmacy

The first few kits were created by Tim Leung and Wendy Gordon, who also managed all the returns (sanitizing individual components). The use of the COVID intubation kits was quickly adopted into Emergency Department practice, subsequently the initiative evolved into a formal process in the RCH pharmacy department involving the technicians and assistants in assembling the kits and incorporation into Omnicell.