USP Statement on Preventing Errors w. Neuromuscular Blocking

In a previous show, we told you about a report from the Institute for Safe Medication Practices (ISMP) which warned about inadvertently giving neuromuscular blocking agents such as pancuronium to patients who aren't receiving ventilator support. This can cause respiratory arrest, permanent injury, or death.

ISMP noted that some errors are due to look-alike packaging and labeling, and recommended placing warning labels on vials, syringes, infusion bags and boxes that say "Warning: paralyzing agent, causes respiratory arrest." ISMP also cited unsafe storage as a cause of errors, and they recommended keeping boxes containing these agents in separate refrigerators and shelves.


ISMP had several other recommendations. For example, allow floor stock of these drugs only in the OR, ED and critical care units, require an independent double check of the drug against the actual order before dispensing and administering, and isolate vials, syringes and infusion bags containing the drug as soon as the patient has been extubated or the drug discontinued.

Now the United States Pharmacopeia (USP) has issued a similar statement warning about these kinds of errors. The USP report lists over 20 recommendations to help solve this problem. Here are a few of them:

• When choosing neuromuscular blocking agents for purchase, select those that have distinctive labeling and packaging.

• Use sealed intubation kits or anesthesia kits in areas outside the OR, which will restrict access until an intubation procedure has begun.

• Except for placing an endotracheal tube, don't administer neuromuscular blocking agents in a critical care setting without medicating the patient for pain or anxiety, even without obvious symptoms or signs.

• Limit orders for these blocking agents to the duration of mechanical ventilation.

• Automatically discontinue all orders for neuromuscular blocking agents when the patient is transferred out of the critical care area. You can see all of the USP recommendations on our web site.

Category:

News & Politics

Tags:

• Neuromuscular
• Blocking
• Agents
• Pancuronium
• FDA
• Respiratory
• Arrest
• Permanent
• Injury
• Death
• Patient
• Safety