Background Ketamine is an anaesthetic agent which can be used to treat pain that is unresponsive to standard treatments. Patients are admitted to the hospice inpatient unit to receive ketamine burst therapy over a five-day period. An audit was conducted to compare current practice against standards derived from regional guidelines.
Methods A retrospective case note audit was completed in July 2020 and using the controlled drugs register, 20 hospice inpatients were identified as having received ketamine burst therapy over the prior three years. The electronic case notes were subsequently analysed.
Results Of the 20 patients who received ketamine, 17 (85%) completed the five-day regimen. Prior to commencing treatment, all patients had a clearly documented rationale and indication and 13 patients (65%) received counselling regarding the risks and benefits. Monitoring of respiratory rate and conscious level at baseline and during treatment was significantly below standard. Only a small proportion of patients (10%) had adequate monitoring of blood pressure and heart rate during treatment; with 4 patients (20%) having documented evidence of a significant rise in either heart rate or blood pressure. Of these, 3 received a ketamine dose alteration.
Conclusion The audit findings strongly suggested that monitoring during ketamine burst therapy was suboptimal and fell below regional standards. As this posed a potential patient safety issue, the findings were presented at a local audit meeting. In response, a Ketamine Pathway was developed to enhance and standardise patient care for those receiving ketamine burst therapy. The Ketamine Pathway outlines recommendations for counselling, opioid dose reduction prior to treatment and twice daily monitoring of vital signs during treatment.It also includes a pre-populated prescription and vital sign monitoring chart. Early evaluation of the use of the Ketamine Pathway in clinical practice is encouraging and re-audit is planned for 2021.
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