1/N
When Should We Label...
Metadata
- Author: @DrNavSidhu on Twitter
- Full Title: 1/N
When Should We Label... - Category: #tweets
- URL: https://twitter.com/DrNavSidhu/status/1664416823851503616
Highlights
- 1/n
When should we label our syringes?
a) At the start, on the empty syringe before anything is drawn up
OR
b) At the end, as the final step after drug +/- diluent drawn up
A brief thread 🧵
#anaesthesia #anesthesiology #PatientSafety #DrugError https://t.co/8ItYZYLwzr (View Tweet) - 2/n
People seem very passionate about their way being the right way. Have also seen different local guidelines
So I thought a poll might shed some light on how we practice.
Turns out we are split 1/3 - 2/3
Or at least my Twitter echo chamber is
(View Tweet) - 3/n
Both approaches are in agreement that this process should be done 1 syringe at a time, and in a single process without the syringe ever leaving your hand.
There should never be a situation with multiple empty (unused) labelled syringes or multiple full unlabelled syringes. https://t.co/wHJJzwbBJF (View Tweet) - 4/n
Also, the process of matching the drug with the label needs to be an active one.
If label already attached, visually match it with the drug vial/ampoule you are picking up.
If drug is drawn up, visually match the vial/ampoule with the label you are sticking on. https://t.co/6MXDMNCoi9 (View Tweet) - 5/n
So, what do they experts say? And what of national guidelines? Let's have a look https://t.co/dHVf5o2r8e (View Tweet) - 6/n
This paper by Merry et al (2011) is often cited in guidelines. It does not seem entirely clear about when the label should be applied, just that it should be an active process.
(View Tweet) - 7/n
I could not find any national or international guidelines supporting the 'label first' approach. I am aware that local guidelines do exist, though.
Closer to home, @ANZCA is ambivalent about which approach to take
(View Tweet) - 8/n
On the other hand, UK guidelines state that 'label after' is the safest approach to take.
This is the link to the @Assoc_Anaes statement: https://t.co/fPIKuDUtzu (View Tweet) - 9/n
They reference European guidelines, which even go as far as stating that the 'label first' approach is unsafe.
(View Tweet) - 10/n
The logic here is that if you place the label on first, then at one point in your process you will have an incorrectly labelled syringe, especially when drawing up drugs that require reconstitution.
Think remifentanil, vecuronium, cephazolin, etc.
(View Tweet) - 11/n
An error could then occur if you fail to complete your process, thinking that the drug has already been drawn into the syringe.
You answer a phone call, machine alarm goes off, someone asks you something, there is an emergency, etc. This may happen even if we are vigilant https://t.co/i38nYkzZKf (View Tweet) - 12/n
Distractions can happen with the 'label after' approach as well.
But now, you have a syringe that is clearly unlabelled in your hands and when this occurs, experts say that it should be discarded and the process should start again. https://t.co/bCDaEye77H (View Tweet) - 13/n
I have also heard people say, "I label first for most drugs but I label after for drugs that need reconstitution."
This is not ideal because it is not a consistent approach, and that in itself can lead to errors.
Have one system. https://t.co/IIIUsmI25G (View Tweet) - 14/n
As an aside, many guidelines say that it's ok to not label a syringe, if the drug is to be given immediately with the syringe not leaving the person's hand.
Merry et al (2011) argue that this may not be safe.
(View Tweet) - 15/end
We are all experts. But we are also human and human experts can still make errors.
It's up to us to find a good, safe, and consistent system that works best in our context.
As long as it's not what he's doing 👇 https://t.co/j4yUco4geA (View Tweet) - Thanks for engaging in the original survey @Harshilvkp @DrCyrusRazavi @MattBeal4 @willtube4food @RobynCJohnston @pritanand @rcmonth @breath_punctual @DrGetafix @Rob_Smithers @icugasdoc @DomENStar @VikkiTipps (View Tweet)