PS51 2017: Medication safety

List:

· Premise

· Aims

· Purchasing

· Drug trolley

· Drawing up and checking

· Labelling

· Administration

· Managing during anaesthesia

· Intravenous infusion

· Disposal

· Record keeping

Premise:

· Anaesthetists don’t cross-check

· Drug errors are common

· Risk of death and maiming

Aims: correct…

· Patient

· Drug

· Dose

· Route

· Time

Purchasing:

· Ensure proper labelling

· Avoid look-alikes

· Minimise need for dilution

Drug trolley:

· Standardised arrangement preferable

· As simple as possible

· As few drugs as possible

· Drugs grouped by class

· Emergency drugs in separate drawer

· Separate similar-looking drugs (e.g. lignocaine and heparin)

· Consider pre-filled and pre-labelled syringes

· Schedule 8 +/-4 drugs locked up elsewhere

· Must have: vasoactives, propofol, relaxants, local anaesthetics

Drawing up and checking:

· Keep in box until drawing up

· Draw up not too long before giving

· Adequate lighting

· Minimise distraction

· Read label before drawing up (name, conc, expiry)

· Read syringe before injecting (name, conc)

· If interrupted, discard it

· Intrathecal drug must be cross-checked

· Don’t split ampoules (i.e. single patient use)

Labelling:

· Pre-printed, colour-coded stickers available

· Syringes labelled with either a) pre-printed sticker b) handwritten sticker c) permanent marker

· Labelling not required if being drawn up and injected without letting go

· Text must be easily legible

· Note open practice (10 bed PACU) more risky than closed practice (1 person OR)

Administration: (need to clarify)

· Identify patient

· Check allergies

· Check written prescription (verbal order ok in emergency)

Managing meds during anaesthesia:

· Neatness:

o Drug tray

o Drug trolley top

· Cleanliness:

o Keep syringes capped (microsterility)

o Alcohol swab for vial tops and injection ports (microsterility)

o Hand hygiene

· Separation:

o Keep emergency drugs apart from the rest

o Different route = different tray (e.g. epidural top up for LUSCS)

Intravenous infusion:

· Standardised syringe drivers and infusion pumps

· Obviously different pumps for IV infusions and neuraxial/regional infusions

· Smart pumps preferable

· Colour coded tubing

· Labelled patient end of the line

· One way valves

· Luer-lock preferable

Disposal:

· Keep used ampoules and vials until end of case

· Bin them yourself

· Schedule 8 +/- 4 disposal must be witnessed and documented

Record keeping:

· Drug + dose + route + time

· Name and signature on chart

Addendum: what are DDs?

· Schedule 4: weak opioids, slow-onset benzos

· Schedule 8: strong opioids, fast-onset benzos

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