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Preventing Medication Errors with Better Syringe Labeling

Categorie : Medical Devices

While there has always been concern in the medical field about medication errors and their effects on patients, the issue has recently been brought to the forefront. The National Committee of Science's 2006 study entitled Preventing Medication Errors: Quality Chasm Series states, "The committee estimates that on average, a hospital patient is subject to at least one medication error per day, with considerable variation in error rates across facilities." [1] Additionally, the FDA has noted that, "medication errors cause at least one death every day and injure approximately 1.3 million people annually in the United States." [2] Adverse drug events (ADE) resulting from a medication error are considered preventable, and estimates of incidences of preventable ADEs range from 380,000 to 450,000 annually in acute care hospitals alone.³

 

Medication errors occur at every stage of the medication process, including administering to the patient, a fact recognized in the Joint Commission's Patient Safety Goals which require "Label all medications, medication containers (for example, syringes, medicine cups, basins), or other solutions on and off the sterile field."

 

The question becomes how nurses can become involved in helping reduce these errors by, for example, using safety syringes with labels and other safety improvements. Some have wondered if nurses even have the time to become involved at this level. According to a recent study sponsored by the American Nurses Association and Inviro Medical and conducted by the Arketi Group, the answer is a resounding yes.

 

Why Errors Occur

 

In this study, 1,039 nurses were asked a variety of questions relating to medication errors, safety, and solutions. A staggering 93% of the nurses surveyed said that they worry about medication errors, and nearly all nurses surveyed (99%) feel there is a grave risk to patients if and when errors occur. Seventy-three percent of the nurses surveyed noted that their rushed environment and busy workload contributed to injectable medication errors, with other factors being noted as well, including illegible handwriting, missed or mistaken physician's orders, working with too many medications, and similar drug names or medication appearance.

 

Safety Syringe Preference

 

When it comes to administering injectable medications, nurses are naturally concerned with both user safety and patient safety.   Looking first at user safety,  the nurses noted that they preferred working with safety syringes overall, and 81% of nurses nationwide that used safety syringes regularly reported never being injured on the job. Of the nurses that used safety syringes, when asked for their technology preferences, 46% stated that they preferred manually retractable syringes, another 46% preferred retro-fitted while 34% preferred automatically retractable syringes.   

 

The nurses who were surveyed offered a range of solutions as to how to improve existing syringes to prevent medication errors and reduce injury. They suggested such improvements as a safety feature activated using one hand, a syringe that would be permanently disabled after the safety mechanism was activated, a way to keep hands and fingers behind the needle when activating the safety mechanism, a needle that would withdraw into the barrel, and a safety feature that was integral to the syringe design. However, the suggestion that was noted the most – with 74% of nurses agreeing – was to include a write-on stripe on the syringe.

 

Altering Labeling Methods

 

The fact is, labeling safety syringes to help avoid medication errors can be challenging. The nurses surveyed identified several of the challenges:

·          the label covers the gradations on the syringe barrel,

·          there is no suitable label available,

·          the label impairs the ability to check the dose and compare to the medication order,

·          the label makes the syringe hard to handle,

·          the label detaches from the syringe,

·          there is no suitable writing instrument available, or

·          the label creates difficulties if the syringe needs to be administered through an IV line or attached to a pump.

 

Most nurses (72% of those surveyed) do attempt to meet the Joint Commission's requirement to label syringes. Of those that do label their syringes, 54%   use self-adhesive labels that they attach to the syringe, 31% use a piece of tape, 4% write the label on a piece of paper or sticky note and attach it to the syringe, and 11% write directly on the syringe with a   permanent marker.

 

Possible Solutions

 

Finally, those nurses were asked about the potential benefits to having a syringe that incorporated a write-on stripe as a part of the barrel. The results were overwhelmingly positive, with 95% of those surveyed noting that such an innovation would not interfere with the visibility of the syringe content or the gradations on the syringe barrel, a concern with other types of syringe labels. Other positives noted by the nurses in the survey included the fact that the write-on label would:

·          reduce the risk of medication errors,

·          address the Joint Commission's requirement for medication labeling,

·          save time,

·          improve productivity,

·          provide a consistent template for applying pre-printed adhesive labels, and

·          eliminate the need for self-adhesive labels or tape.

 

Conclusion

 

There is a clear need for safe and easy ways for nurses to label syringes when dispensing medication to prevent medication errors. Many hospitals now have rules in place requiring labels if the syringe will be moved from room to room or even if the syringe will be put down before being used. The addition of a way to label safety syringes that is incorporated into the syringe itself is clearly something that many nurses are interested in and would utilize. And with a label that is more likely to be used, medication errors and the adverse drug events which result from medication errors may be reduced.

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