PS51 2017: Medication safety



·         Premise

·         Aims

·         Purchasing

·         Drug trolley

·         Drawing up and checking

·         Labelling

·         Administration

·         Managing during anaesthesia

·         Intravenous infusion

·         Disposal

·         Record keeping



·         Anaesthetists don’t cross-check

·         Drug errors are common

·         Risk of death and maiming


Aims: correct…

·         Patient

·         Drug

·         Dose

·         Route

·         Time



·         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, chuck it out

·         Intrathecal drug must be cross-checked

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



·         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



·         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, long-acting benzos

·         Schedule 8: strong opioids, short-acting benzos


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