Watch Out! These Injection Practices Endanger Safety and Compliance

Increased scrutiny of safe injection practices over the past several years, particularly in the ambulatory surgery setting, has helped motivate organizations to improve their practices, as Infection Control Consulting Services (ICCS) consultants have observed during on-site visits throughout 2018. In particular, we have witnessed improvements in areas including multi-dose vials, labeling of syringes, storage of injectables and accessing injectable medications in a non-patient care area if used for more than one patient.

While observed practices have improved overall, we continue to visit facilities that, despite showing improvement during previous visits, have encountered circumstances that create a "fall-off-the-rails" situation. As a result, practices are, once again, found to be out of compliance.

A recent visit to a high-volume pain management facility with a short-staffed anesthesia department presented many examples of major breaches in safe injection practices that could potentially put patients in danger. We share them here in the hopes that other organizations can ensure they are not repeating these practices.

7 Unsafe Injection Practices

1. Injectable medications previously drawn up in direct patient care areas were left on top of the anesthesia cart. Medications included sodium chloride and a syringe with a white milky substance (presumably Propofol). They were found in the unattended operating room between procedures.

2. Anesthesiologist carried a basket with several filled syringes and some empty syringes which had been removed from their packages from room to room. All syringes (empty and filled) had syringe caps on them, but filled syringes had been drawn up in the rooms (direct patient care areas) in advance of cases.

3. A multi-dose vial of Propofol with a spiking device was in the basket and carried back and forth between rooms.

4. An opened, unlabeled multi-dose vial of Labetalol was found in the procedure room anesthesia cart.

5. The rubber diaphragm of the vial was not wiped with alcohol prior to drawing up medication.

6. The IV port, or hub, was not "scrubbed" with alcohol prior to injecting medication.

7. Anesthesiologist did not change gloves between patients and went from room to room with the same gloves, failing to perform hand hygiene. During conversation with the consultant and anesthesiologist, the consultant learned that the anesthesiologist was overwhelmed by the volume of procedures and concerned about "tripling the time" for each procedure due to "practicing safe injection practices according to nationally recognized guidelines and standards."

Cutting Corners = Potential Patient Harm

Patient safety with respect to injectable medications is paramount and the most important consideration when rendering injection services. Clinicians should speak up if the schedule is unmanageable and feeling pressured to practice poorly for the sake of maintaining the high volume to increase revenue. It is imperative to remind staff that a facility survey by Medicare, the state or an accreditation organization will only pass muster if practices put in place to keep patients safe are effective and undertaken appropriately. Our primary goal in rendering care is to provide patients with a safe and healthy environment. Anything that jeopardizes this mission must be avoided.