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10th August 2023
New guidelines on the handling of injectable medicines used in anaesthesia, which provide pragmatic safety steps for practitioners within the operative environment to help reduce errors, have been published in the journal Anaesthesia.
Peri-operative injectable medication safety is vital yet a complex process and in order to avoid medication errors, it requires a system- and practitioner-based approach. As a result, the Association of Anaesthetists, together with UK bodies including NHS England, pharmaceutical organisations and the Royal College of Anaesthetists, have produced clear advice on how to reduce avoidable errors in every step of the pathway involving the injectable medications used routinely in anaesthesia care.
Although two-person checking is a common practice in many areas of healthcare, the preparation of medication that includes the transfer from labelled ampoules into unlabelled syringes is normally a sole pursuit undertaken by an anaesthetist.
This clearly introduces the potential for error and the authors of the new guidance say that labelling errors have been noted in around 1-1.25% of peri-operative medication administrations and medication substitutions in 0.2% of administrations during anaesthesia. Therefore, considerable emphasis has been placed on reducing medication errors via a systematic approach.
Part of the guidance highlights the importance, utility and enhanced safety offered by prefilled and labelled medication syringes, as well as the use of aids such as colour-coded medication trays that can help the anaesthetist correctly organise the syringes before and during anaesthesia. Neither of which are yet in widespread use in the NHS.
In addition, the guidance emphasises that medication safety does not depend solely on the individual practitioner, but that many departments within the hospital should also contribute to safe systems.
When it comes to pharmacy’s role, for example, the guidance suggests that, if feasible, a medication safety officer should liaise with a designated pharmacy procurement professional and a clinical pharmacist in the department of anaesthesia over all decisions relevant to medication purchasing and presentation.
The new guidance provides eight key recommendations:
The authors suggest that their guidelines aim to provide pragmatic safety steps for practitioners and other individuals within the operative environment, as well as short- to long-term goals for development of a collaborative approach to reducing errors. It is also hoped that the guideline will be used as a basis for instilling good practice.
The authors said: ’“First do no harm“ is what doctors strive for. We hope that these guidelines provide useful points for anaesthetists’ individual practice, while acknowledging that patient safety also relies on supportive systems within their hospitals.’
Image credit: Dr Mike Kinsella.