Transcript Slide 1

User-applied Labelling of
Injectable Medicines, Fluids
and Lines1
Staff Training
(Name of Presenter)
Developed by Medicines and Technology Policy and Programs
SA Health
1 Copyright: Australian Commission on Safety and Quality in Health Care
User-applied Labelling
Recommendations
> Developed by the Australian
Commission on Safety and
Quality in Healthcare 2010*.
> Aim for a single,
comprehensive national
recommendation for clinical
practice.
> Apply to all public health
facilities nationwide.
* Updated February 2012
SA Health
Labelling for Safety
> Labelling of injectable medicines, fluids
and delivery devices is a major patient
safety issue.
> Labelling is often not done or is
incomplete, omitting information such
as:
• name of medicine
• medicine dose
• patient name
• time of preparation.
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Reason for the recommendations
Safety in labelling
> Errors attributable to labelling have
been associated with:
• the multi-step process when preparing
bolus injection or infusion
• absent or inadequate labelling
• patient transfer
• sterile field - inconsistent practice
• 0.9% sodium chloride flush
• line misconnections.
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Reason for the recommendations
Medicine administration errors
Case Report 1
> 10mg morphine was given in error as
the clinician thought the syringe
contained 0.9% sodium chloride. The
unlabelled morphine syringe had a
0.9% sodium chloride ampoule
attached (unpublished).
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Reason for the recommendations
Medicine administration errors
Case Report 2
>
A patient was given intravenous (IV)
lignocaine with adrenaline solution
intended for local anaesthetic
infiltration. This syringe had been
drawn up and placed in a kidney dish
alongside IV morphine and
midazolam for procedural sedation
(unpublished).
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Labelling Recommendations
Development
> Draft recommendations developed by
NSW Therapeutic Advisory Group Safer Medicines Group.
> National consultation and pilot testing,
supported by the Australian
Commission on Safety and Quality in
Health Care, commenced in 2009.
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Labelling Recommendations
Development
> Recommendations are based on:
• international literature/recommendations
• Australian Standard AS4940: User-applied
identification labels for use on fluid bags,
syringes and drug administration lines.
• expert opinion
• pilot testing
• reported medicine administration incidents.
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Labelling Recommendations
Consultation
> The draft Labelling Recommendations were
developed in consultation with:
• All state and territory health jurisdictions
• All state and territory Safer Medicines Groups
• The Council of Australian Therapeutic Advisory
Groups
• 13 national peak professional bodies.*
> Pilot tests conducted in 2009-10 across 12
clinical areas in 8 hospitals (including Mt
Gambier Hospital, SA)
*National Recommendations for User-applied Labelling of Injectable Medicines, Fluids and Lines August 2010 Appendix 3
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Labelling Recommendations
Aims
> provide standardisation for userapplied labelling of injectable
medicines
> provide minimum requirements for
user-applied labelling of injectable
medicines
> promote safer use of injectable
medicines.
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Labelling Recommendations
Minimum requirements
> medicines or fluid removed from original
packaging must be identifiable
> all containers (e.g. bags and syringes)
containing medicines must be labelled on
leaving the hands of the person preparing
the medicine
> prepare and label one medicine at a time
> discard medicines or fluids in unlabelled
containers.
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Labelling Recommendations
Outline & Scope
> what should be labelled
> what should be included on the label
> where the label should be placed
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Labelling Recommendations
Exclusions
> injectable medicines and fluids prepared
by hospital pharmacy departments or
external manufacturers
> administration portals
> syringe drivers and pumps
> enteral, topical or inhalational medicines
> preparation and bolus administration of
a SINGLE medicine from a SINGLE
syringe in one uninterrupted process.
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Labelling for medicine additives
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Labelling Recommendations
Identifying target tissue/
route of administration
> A standard colour system is used to
identify the target tissue/intended route
of administration
Target tissue
Route of administration
Colour
Intra-arterial
Intra-arterial
Red
Intravenous
Intravenous
Blue
Neural tissue
Epidural / Intrathecal / Regional
Yellow
Subcutaneous tissue
Subcutaneous
Beige
Miscellaneous
Any other route not specified
above
Pink
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Medicines
Bag and syringe labels
> IntraVENOUS, EPIDURAL, IntraTHECAL, REGIONAL,
Subcutaneous and Miscellaneous use
> Available in 2 sizes
> Use of TALLman lettering
All Containers
Label content
DOB 01/06/1966
> Patient: Given name & family name
> Identifier (ID): This is the URN or MRN
> DOB: Date of Birth
> For each medicine added to the container specify:
• generic medicine name
• amount
• total milligrams, grams, micrograms added to bag or
syringe
• volume
• total volume of fluid in the container – expressed in
millilitres (mL).
SA Health
All Containers
Label content
DOB 01/06/1966
> Concentration
• addition to current labelling process for most
facilities
• calculation of the amount of medicine in the bag
or syringe per mL.
> Amount of medication (ie mg) / volume (mL)
• ceftriaxone in NaCl bag: 1000mg/500mL = 2mg/mL
• morphine in WFI syringe: 10mg/4ml = 2.5mg/mL
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All Containers
Label content
DOB 01/06/1966
> Diluent
• complete for all syringes
• not necessary if applying to bag with diluent
pre-printed
> ‘Date’ and ‘Time’
• when the medicine is prepared
> ‘Prepared by’ and ‘Checked by’
• to be signed by person responsible
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All Containers
Label content
> If two medications
are added, the
concentration
must be added for
both.
> All additions
should be added
on the same label.
DOB 01/06/1966
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User-applied labelling of injectable medicines |
IV bag
Label placement
> Place labels on the
FRONT of the bag
> This ensures the
type of base fluid,
batch number and
expiry date remain
visible.
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Syringes
Label placement
> Place label so graduations on the syringe scale
remain visible
> Apply parallel to the long axis of the syringe barrel,
top edge flush with scale
> ‘Flag’ for small syringes
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Medicines
IV flushes
> Label any fluid drawn up in a syringe
for use as an IV flush (e.g. 0.9%
sodium chloride) unless preparation
and bolus administration is one
uninterrupted process
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All Containers
Discarding content
> Recommendations address the risk of
administering an unidentified fluid.
> Discard:
• any unlabelled container holding a solution
• any container, where there is doubt over
content
• any medicine remaining in the container at
the end of a procedure.
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Medicine
Burettes
DOB
> Use ‘peel-off’ labels
reserved for use on
burettes ONLY.
> Place label so that text is
upright and ensure that
the burette graduations
are not obscured.
> Burette labels must be
removed once the
medicine has been
administered to the
patient.
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Labelling for administration lines
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Lines and catheters
Route of administration
 Available for intraVENOUS, CENTRAL VENOUS,
EPIDURAL, intraTHECAL, REGIONAL, subcutaneous
and intra-ARTERIAL and miscellaneous.
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Lines and catheters
Route of administration
> Labelling administration lines and catheters
• label all lines to identify route
• add date and time the line change is due
• identify catheters where there is a risk of wrong route
administration, e.g. where the patient entry portal is
distant from the administration site.
> Labelling invasive monitoring lines
• identify all lines, including those not primarily intended
for medicine administration.
12/07/2013
14:00
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Lines
Active ingredient
> Identify the active ingredient within
administration lines dedicated for
continuous infusions.
> Pre-printed line labels are also permitted.*
> Lines for other infusions (e.g. intermittent)
may be labelled for medicine content.**
*See pre-printed medicine line labels for continuous infusions section of this presentation
** Always ensure the label is removed on completion of infusion
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Lines and catheters
Label Placement
> Route label
• Use colour coded route label
• Label near the injection port on the patient side
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Lines and catheters
Label Placement
> Medicine label
• Use generic medicine label.
• Label close to patient entry portal adjacent to route
label.
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Peri-operative environments
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Pre-printed medication labels
> The National anaesthetic guidelines AS/NZS
4375 for pre-printed medication labelling of
syringes is recognised by the Labelling
Recommendations.
> Pre-printed labels have specific colour coding
associated with drug class.
> Only appropriate for use in environments
where the patient is recognised as identified
(within Theatre, in an Ambulance or retrieval
emergency).
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Peri-operative environments
> Labelling of syringes containing drugs used during
anaesthesia to comply with AS/NZS 4375.
> Labelling of bags, syringes, lines, catheters and
invasive monitoring lines in all areas of the perioperative environment, other than drugs in
syringes used during anaesthesia, are to comply
with the Labelling Recommendations.
> Use abbreviated container label in operating room
where patient identity is established and there are
other means of recording labelling and preparation
signatories.
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Pre-printed Medicine Line Labels –
Dedicated Continuous Infusions
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Dedicated Continuous Infusions
> Dedicated continuous infusions may be labelled
with a pre-printed line label.
> Concentration is not required.
> Colour-coding on pre-printed labels should follow
the anaesthetic standard (AS/NZS 4375)
EXCEPT
•
High risk medicines that fall in the ‘miscellaneous’ category
should be printed red on white
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Pre-printed Medicine Line Labels –
Syringe labels in interventional cardiac
catheter and radiology laboratories
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Syringe labels in interventional cardiac
catheter and radiology laboratories
> Syringe labels in interventional cardiac catheter
and radiology laboratories may be labelled with a
pre-printed line label.
> Concentration is not required.
> Colour-coding on pre-printed labels should follow
the anaesthetic standard (AS/NZS 4375)
EXCEPT
>
>
>
>
>
antiplatelet agents/anticoagulants to be labelled with teal green
(PMS 3255)
heparin to be teal green with a black border
protamine to be teal green with a black diagonal stripe border
heparinised saline to have a teal green border (PMS 3255)
contrast to have a brown border (PMS 471)
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Syringe labels in interventional cardiac
catheter and radiology laboratories
> Examples of the cardiac and radiology syringe
labels can be found at:
http://www.safetyandquality.gov.au/our-work/medication-safety/safer-naming-labelling-andpackaging-of-medicines/user-applied-labelling/
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Labelling for Safety
e-learning
SA Health
Labelling for Safety: e-learning
> SA Health has developed an e-learning
tool – Labelling for Safety
> The course is intended for clinical staff
involved in direct patient care
• in particular, for staff involved in the preparation
and administration of injectable medicines in a
clinical or ward area.
> Access the course at:
http://digitalmedia.sahealth.sa.gov.au
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SA Label - For Enteral Use Only
SA Health
SA Label – For Enteral Use Only
> South Australia has developed a label for
enteral feeding lines.
> Label aligns with the Australian Standard
including colour and size.
DOB
DOB
Enteral Bag Label
Enteral Syringe Label
Enteral Line Label
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Our Implementation
SA Health
Implementation
Our plan for implementation
> Include details here of:
• Implementation date
• How you will be running education
• If you did the implementation survey give some
of the results about focus areas…
• Plan for withdrawing old labels
• People to contact on site for questions
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Posters
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Questions?
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