HPE HPE 85 – Spring 2017 - Page 39

Pharmacy practice Issue 85 | Spring 2017 Despite this, they felt that one to five minutes of nursing time is saved when preparing fentanyl 2500mcg in 50ml infusions using the 50ml (50mcg/ml) vials compared with using the 10ml (50mcg/ml) ampoules. Reduction in errors The reduction in potential for error during dose preparation is quantified by the reduction in the NPSA risk score. The impact of the RTU product on errors in practice is more difficult to measure as errors associated with the preparation of infusions are rarely identified once the infusion has been commenced. We know of one error with the preparation of a fentanyl infusion on a critical care unit that was identified during the checking process prior to it being administered to the patient. Five 10ml ampoules of fentanyl were taken out of storage for the preparation of a syringe to contain 2.5mg fentanyl in 50ml. During the final check it was noticed that an ampoule of noradrenaline had been mixed up with the fentanyl ampoules and incorporated into the contents of the syringe. The syringe was discarded and the dose remade. This type of mix up cannot happen if single 50ml vials are used to prepare a dose instead of multiple 10ml ampoules. Conclusions The introduction of RTU vials of fentanyl has had a positive impact on practice with limited impact on cost. The use of RTU products instead of ward-based dose preparation is in line with national guidance for safe use of medicines. The long shelf-life of vials is an advantage over pre-filled syringes, which have a shorter shelf life making wastage more likely. The presentation of drugs in vials allows for clear, well designed labels to ensure correct product recognition. This product has recently been enhanced further with the addition of an integrated peelable label to be transferred from the manufactured vial to the prepared dose in the syringe. This replaces the need for handwritten syringe labels and ensures that the contents of prepared syringes will be easy to recognise during administration as well as during dose preparation. We believe that the advantages of using this product in terms of CD storage and convenience in syringe preparation, releasing valuable nursing time to care for our most ill patients, and complying with national guidance for safe use of injectable medicines outweigh the small financial impact of purchasing a RTU product. Medication safety pharmacists should be involved in sourcing and promoting the use of new drug presentations such as this and should use their knowledge of the way drugs are handled at ward level to influence the product 2W&66VBf"W6PvFFV"7F2vW&R&676W76VG2BWfVF2bWp&GV7G2fR&VV6GV7FVBFW6P6VB&R6&VBvF6VwVW2fƖRWGv&2शWG0( "fVF26G&VBG'VrW6VBখG&W&FfRvW6F֖7FW&V@VFW"'7V66W76fRG&fVW0V7F2"'G&fVW2gW6( "&VGFW6Rf2bfVFfPB6FfR7B&7F6RvFƗGFR7B67B( "W6RbFRf2&VGV6W2FR4&666&Rf"FR&W&FbfVF"VrS7&vW2g&2&W"F"w&VV( "W'6W2fBW6RbFR&VGFW6Pf2V6W"6fW"B6W"FFPVW2( "VF6F6fWG&67G26V@W6RFV"vVFvRbFƖr`G'Vw2Bv&BWfV&FrFPW6Rb6֖"G'Vr&W6VFF2&VfW&V6W0FFVB6fWGvV7FVB6fWGW'@#&Fr6fW"W6RbV7F&RVF6W2F#rwwr&262V&W6W&6W2VG'CCSS66W76VB&#r"TԒ66V7W2Ɨ7Bv&6V7F&PVF6W2fW'6"fV&W"#2wwrVF6W7&W6W&6W22VWBF7VVG2WfFV6RVF6F6fWG4#S#vS#&6S#66V7W2S#Ɨ7BS#fS#bS##2Fb66W76VB&#r2&'Fv6WB7W'fWFf&Ч7FF&F6FbG&fVW2VF6F66VG&F27&F66&RFV6fR6&R60#s"B&'Fv6WBFv&G27FF&F6FbG'VpgW666VG&F2T7&F66&RVG2ढFV6fR6&R62#~( 3#RBf&V'6֗GFVR'&F6Ff&V'cVBF$Ԣw&W@&6WWF6&W73#BVV&R&V2WB7&vRvR6W'FW7bV␣3p7F&7WW&R6