Topical application of chlorhexidine and the risks of accidental injection
A joint safety statement was developed in response to reported incidents of accidental injection of chlorhexidine. Typically, the accidental injections are associated with drawing up chlorhexidine from gallipots, rather than following national anaesthetic and user-applied labelling guidelines and standards.
The statement includes recommendations consistent with the National standard for user-applied labelling of injectable medicines, fluids and lines and ANZCA’s PS51 Guidelines for the Safe Management and Use of Medications in Anaesthesia, including the use of dark-tinted chlorhexidine for skin preparation is advocated, as light-tinted chlorhexidine increases the risk of errors.
Neuraxial connectors and ISO 80369-6:2016
Internationally, safety organisations have tried to reduce the incidence of erroneous injection through education, storage, and labelling of medicines and devices, including the National standard for user-applied labelling of injectable medicines fluids and lines.
The International Standard ISO 80369-6:2016 Small bore connectors for liquids and gases in healthcare applications – Part 6: Connectors for neuraxial applications was introduced with the aim of reducing the erroneous, harmful administration of fluids via intrathecal, epidural and other neural routes and reducing erroneous administration of substances intended for neural routes to other sites. ISO 80369-6:2016 specifies the design and dimensions of small-bore connectors for neural applications, including neuraxial, peripheral and regional applications.
The Australian and New Zealand College of Anaesthetists (ANZCA) and the Commission have published a joint statement and guidelines with a safety checklist to support the implementation of medical devices with ISO80369-6:2016 compliant neural connectors in Australia.
Safety statement on metered dose inhalers
The Commission recommends established metered dose inhalers are prescribed and communicated by the metered dose, even if the product is labelled with additional information on the delivered dose.
The labelling and packaging of established metered dose inhalers and other metered dose products may state the quantity of active ingredient per metered dose and the quantity of active ingredient in a delivered dose. It is recommended where both doses are described, these products are:
- Prescribed and communicated by the metered dose
- Labelled at point of dispense with metered dose. The delivered dose may also be displayed if clearly described, such as ‘each inhalation contains a metered dose of (X micrograms) which is equivalent to a delivered dose of (Y micrograms)’.
Paediatric Prescribing Position Statement
This statement promotes best practice in prescribing, dispensing and administering of medicines for paediatric patients. The Paediatric Prescribing Position Statement includes recommendations to:
- Document date of birth and current body weight,
- Basis for dose calculation (mg/kg) and dose in units of mass (mg) in all paediatric prescriptions
- Verify all dose calculations and the total dose discuss the dose with parents and carers.