P26 Switching from unlicensed oral Midazolam liquid to a licensed product for preoperative sedation

Background This specialist children’s hospital used unlicensed midazolam 2.5 mg/ml oral solution for preoperative sedative. product had various problems such as a bitter taste which often led to poor patient acceptability and short expiry once opened. In this Trust is stored recorded in CD registers discrepancies the running balance are reported clinical incidents destruction of expired stock also time-consuming. When licensed 5 single dose preparation became available, wanted investigate whether switch would be beneficial. The new supplied orange flavoured. Method Pharmacy completed ‘new drug risk assessment’ ensuring that excipients were appropriate paediatric patients. assessment identified possible associated with implementation across trust (eg different strength, use bottle, time taken dispensing bottles rather than storage capacity multiple bottles, changes documentation registers) [This stores records cupboards]. Any potential cost pressure was highlighted finance department. A pilot undertaken 10 Nurses anaesthetists asked feedback regarding prior implementing complete switch. electronic prescribing system updated, communications circulated alert all staff change product. Results All nurses involved positive their evaluation Comments ‘the child took well then accepted other medicines’ recorded. Since occurred there have not been any issues balances or safety involving midazolam. areas no impact upon department due increased workload based record keeping. moving from clinicians has continued particularly relating improved compliance both flavouring smaller administrative volumes. pharmacy requests return destructions remaining liquid carried out at ward level. additional £18,300 but happy offset against reduced cancelled operations inadequate pre-medication. nursing noted practice. neutral although times more dispensed per order required destroy stocks. Conclusion move pre-medication resulted better compliance, adversely affected.