HPE HPE 85 – Spring 2017 - Page 37

Pharmacy practice Issue 85 | Spring 2017 The impact of ready-to-use fentanyl vials The introduction of ready-to-use fentanyl vials with integral, peelable syringe labels reduces the risk of compounding errors with this high-risk drug and releases valuable nursing time to care for critically ill patients Gillian Cavell MSc FFRPS MRPharmS Consultant Pharmacist, Medication Safety King’s College Hospital NHS Foundation Trust, London, UK In UK hospitals, trained nurses prepare injectable medicines for administration to patients against prescriptions written by doctors. Other than parenteral cytotoxic agents, few drugs are prepared in centralised pharmacy-led aseptic units as ready-to-administer (RTA) doses. Although the preparation of injectable medicines is checked twice by two qualified practitioners, the risk of error, particularly with complex processes and potential for patient harm, is recognised. In March 2007, the National Patient Safety Agency published a patient safety alert to promote the safe use of injectable medicines. 1 The alert provided a simple scoring system for assessing the risks associated with ward-based preparation of injectable doses (Table 1). The alert recommended that high-risk injectable medicines should be provided in the most appropriate vial or ampoule sizes and that RTA or ready-to-use (RTU) injectable products should be used to minimise the risk of error in dose preparation and administration. Fentanyl infusions are included in the United Kingdom Medicines Information (UKMI) Consensus List of High Risk Injectable Medicines. 2 In 2007, a survey on the use of injectable medicines in UK critical care units was conducted to identify frequently used concentrations of injectable medicines and propose standardised concentrations for use in UK hospitals. 3 Results of that survey identified that 88% of 154 UK critical care units administered fentanyl by continuous Ready-to-use fentanyl vial showing peelable label with syringe label underneath (image courtesy of hameln) infusion in a concentration of 50mcg/ml from 50ml syringes. When the same authors proposed a standardised preparation of fentanyl 2.5mg in 50ml (50mcg/ml) 91% of 113 critical care units stated that they would use that concentration. 4 However, until recently, a licensed fentanyl product of the corresponding volume has not been commercially available. Our facility King’s College Hospital is a large acute teaching hospital in south London. There hospitalpharmacyeurope.com 35