Abstract P-472: SEDATION WEANING-HOW WELL ARE WE ADHERING TO SEDATION GUIDELINES?

Abstract

Aims & Objectives: Sedation withdrawal is common when patients receive intravenous opioids in paediatric intensive care unit (PICU). Current practice is to transition intravenous opioids to enteral methadone, monitoring for withdrawal using the withdrawal assessment tool (WAT). Adherence to current sedation weaning guide is unknown. Objective: To evaluate methadone prescribing and assessment of withdrawal assessment in the PICU. Methods A retrospective audit of PICU patients who received methadone was conducted from 2nd June 2016 till 13th March 2017. Criteria for adherence assessment: appropriate conversion to enteral methadone, assessment of WAT, and appropriate weaning of methadone. Data collected patient demographics, diagnosis and indication for methadone. The audit focused on: • Proportion of patients that were prescribed methadone and adherence to the current weaning guide. • Proportion of patients that had a documented assessment of withdrawal. Results Fifty-five patients received methadone in the nine months. Indications were: 20% ventilation transition, 27% weaning intravenous opioids, 44% both ventilation/transition & weaning intravenous opioids, and 9% an adjunct for pain and/or sedation. An average methadone wean was 10 days whilst in PICU, and 21 days if the patient transitioned to the ward. Assessment of withdrawal with a documented WAT score occurred in 33% of the patients. Adherence to the PICU methadone guide occurred in 28% of patients, 74% of patients transitioned appropriately from intravenous opioids to enteral methadone. Conclusions More work is required to ensure that all patient’s receiving methadone are assessed for withdrawal. Development of a sedation guide that encompasses withdrawal scores and methadone wean recommendations should improve withdrawal management in the PICU.