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

 

 

Feedback welcome at ketaminenightmares@gmail.com