O59 Intranasal diamorphine: a pain in the nostrils? interprofessional simulation to test a new drug delivery system

Background/Context/AimsThe Scottish Medicine Consortium approved a newly licensed preparation of intranasal diamorphine (Ayendi) for prescribing in NHS Scotland in July 2016.1 Intranasal diamorphine is a potent analgesic which is used to treat acute severe pain in children less than 16 years old. Previously, an unlicensed preparation was used in accordance with a local prescribing guideline for use in the Emergency Department. Scottish prescribing recommendations are that unlicensed medicines should only be used due to unavailability of appropriate licensed preparations. Therefore, evaluation of the new product was required to assess the appropriateness of use in the emergency department (ED) setting. Summary of Product Characteristics review had identified areas of concern regarding patient safety, security and controlled drug documentation.2 The study aim was to use interprofessional simulation to evaluate the new intranasal diamorphine. To our knowledge, previous use of simulation to identify potential unintended consequences of implementing new medicinal products into practice has not been tested.Methodology/Project DescriptionInterdisciplinary simulation with video recording of a specific scenario using new product dummy samples was the selected method. Simulated child and mother were ED staff members. Immediately prior to simulation, training about the new product was provided by a pre-registration pharmacist to all involved staff. A post-simulation debrief was completed by the simulation lead and questionnaires distributed to further gain participants’ insight of the trialled preparation.Results/OutcomesThe simulation using dummy samples was completed. All participants (n=9), a convenience sample of medical and nursing staff, consented to involvement and simulation recording. Simulation was observed in real time and on completion, debrief was conducted by the simulation lead (an ED consultant). Identified issues included: * Patient safety concerns with overdose potential as multidose vial presentation * Concerns regarding accurate deploy of product (patient needs to be sitting upright) * Risk of powder spillage and misappropriation * Infection control issues due to changing nozzles and exposure of powder * Significant nurse time to prepare and complete required controlled drug documentation resulted in reduced patient nursing care Analysis of completed questionnaires (n=9) indicated that no respondents were in favour of changing to the new product u