Immediate availability of a box of Sugammadex in every theatre anaesthetic trolley offers an increased level of patient safety. Cost is often used as an excuse by many departments for not doing this however several economic trials have demonstrated that the increased patient safety it affords actually leads to decreased costs overall. Unfortunately often those involved in making the decisions about the availability of Sugammadex have been providing anaaesthetics for years and ‘never had a problem’ – ego and cognitive dissonance prevent the introduction of a patient safety solution.
Progress:
We have created a petition to reduce costs to make the availability of Sugammadex more palatable to all departments.
We hope to help improve education about the value of this drug to patient safety through this post.
Help:
Please sign the petition to MSD to reduce the price of Sugammadex.
If you know of any institution which does not allow immediate in theatre access to a box of Sugammadex then please forward this post on to them.
People are more likely to administer a poison when the antidote is immediately available. Anaesthetists are more likely to provide rocuronium muscle relaxation to their patients when Sugammadex is immediately available.
Click here – could an un-opened box of Sugammadex have saved Elaine Bromiley?
‘No longer should Sugammadex be kept hidden away centrally in some locked cupboard, but available immediately to hand in the anaesthetic/operating room.’
See: Editorial of 2015 Difficult Airway Society Guidelines.
Immediate (in theatre drug trolley) Sugammadex will benefit rapid reversal where a patient’s deteriorating airway can just be ventilated:
‘We found that costly time was lost because sugammadex was not directly available in the operating theatre. This decision was made at a managerial level because sugammadex is an expensive drug.’ (See Anaesthesia Sept 2010)
Understandably hospital administrators have warmed to those anaesthetists proclaiming immediate access to Sugammadex is unnecessary – it takes the pressure off them and their budget – this is very short sighted as there are numerous hidden cost benefits to Sugammadex (see here). This in turn leads to stress on front line staff members who understand immediate access is in the interest of optimal patient management.
There are several reports of successful Sugammadex use in airway rescue: (see here) However it’s vital we educate its use is unreliable in airway emergency. It is unlikely appropriate in a CICO situation. For those pre-emptively considering its use when managing a difficult airway perhaps understand that an alternative approach will be more suitable.
It’s intuitive, that in rare cases of airway rescue if rapid reversal may benefit, a sufficient dose of Sugammadex needs to be immediately available in the theatre drug trolley.
A box of 10 vials of 200mg Sugammadex ensures a 16mg/kg dose for patients weighing up to 125kg.
The cost of Sugammadex restricts availability. From our understanding the cost of a 200mg vial in Australia varies from A$45 to 195 depending on contract agreements.
There are institutions who do not purchase it, and others who only make it available from a centrally located locked cupboard.
We present a tiered approach to Sugammadex restriction which limits use but ensures immediate availability in sufficient dose:
We hope that healthcare institutions adopt this approach enabling optimal patient safety while allowing for current cost constraints.
How you can help:
1. Ensure your institution has immediate access (in theatre drug trolley) to sugammadex so it may be rapidly drawn up to reverse a large induction dose of rocuronium (1.2mg/kg).
2. Offer to perform an audit of Sugammadex usage.
3. Sign the petition requesting Merck reduce the price.
4. Forward any interesting anecdotal cases where the presence or absence of Sugammadex may have had a significant impact (avoid any identifiers).
5. For those colleagues still undecided about the benefits of unrestricted access to Sugammadex provide a link to the following article:
Sugammadex – What Price Are We Willing To Pay?
While Merck did not develop Sugammadex, through a series of acquisitions they now control the price.
Sugammadex is overpriced.
This is detrimental to patient care and places unnecessary stress on hospital staff. We should encourage Merck to reduce the price so we may all benefit from unrestricted access. This is after all their company mantra:
We ask that Merck do the right thing – the healthcare community won’t forget their decisions – we can only hope that Merck remember ‘medicine is for the people‘.
Sign the petition requesting Merck reduce the price.
We sent this letter to the CEO of Merck on 21st May 2016 – we await his reply.
Please note that patientsafe has no financial interest with Merck (MSD) or Sugammadex.