5 Points on Preventing Injection Errors in the Surgical Setting

This is the second article in a series of five articles focused on the most pressing issues in patient safety and infection control, published during International Infection Control Week. The series is sponsored by X-Static. Access the first article on hand hygiene here.

Gina Pugliese, RN, MS, is vice president of Premier's Safety Institute and a member of the Premier Safe Injection Practices Coalition, which aims to study and prevent unsafe injection practices. In 2009, a hepatitis C outbreak in southern Nevada was linked to the reuse of propofol vials, leaving patients infected with incurable liver disease.

Drug shortages and low reimbursement for pain procedures mean that providers are often tempted to cut corners, reusing needles and vials in order to save money. But the consequences can be life-threatening — hence the CDC's "One and Only Campaign," which aims to raise awareness about safe injection practices.

Here, Ms. Pugliese discusses five things providers can do to prevent unsafe injection practices.

1. Champion "one needle, one syringe, one time." Premier's Safe Injection Practices Coalition recently conducted a survey to determine how widespread the problem of unsafe injection practices is. Of the 5,500 people who responded to the survey, approximately 1 percent reported re-using single-dose vials on multiple patients. 15 percent reported re-using a syringe to enter a multi-dose vial, and 6 percent of that 15 percent saved that multi-dose vial for use on another patient. Ms. Pugliese says these numbers point to a serious problem: "We didn't try to trick them by saying, 'Are you doing this terrible thing?'" she says. "We just said, 'How often do you do this?' And people were very honest."

She says facilities should maintain a zero-tolerance approach to the re-use of single-dose vials or the re-use of syringes on multi-dose vials. "We're bringing together providers from different professional organizations and asking them to educate their professionals," she says. Education has been more difficult in some areas, such as pain, where low reimbursements are a problem for physicians.

For example, Medicare reimburses for pain procedures but not for all the medications used for the procedures. "Physicians had a tendency to re-use single-use vials until this campaign started," she says. In your facility, she recommends sitting providers down with a video and an explanation of why this is important. Emphasize that this is not an option: "one needle, one syringe, one time" is mandatory.

2. Empower patients to speak up. Patients need to be educated about unsafe injection practices as well. "Patients are so much more prepared now than they used to be," Ms. Pugliese says. "They're asking questions and demanding information." She says she recommends that facilities post signs that inform patients about safe and unsafe injection practices.

That way, if the patient notices that he physician is re-using a single-dose vial or using a syringe tinted with blood, they can speak up. "If the patients from the terrible outbreak in Nevada had known what was happening, they could have said something," she says.

3. Post signs, slide programs and education materials  in your facility. You can't educate too much on a topic that saves patients' lives, Ms. Pugliese says. The One and Only Campaign and the Premier Injection Practices website offer a number of resources for providers, including posters, slides for physicians to browse in their free time, and brochures for patients to read. Make "best practices" visible in your facility to remind providers and patients of the rules.

4. Survey your facility. Ms. Pugliese says the survey conducted at Premier was so effective because it didn't put providers on the defensive — it simply asked, "How often do you do this?" You need to know whether your facility has a problem with unsafe injection practices; the practice may be widespread among your staff without anyone realizing it's a problem.

Ms. Pugliese recommends distributing a survey or assigning "secret shoppers" to departments to watch injection practices and determine how often providers are not complying. A survey can be relatively informal and give you an idea of misinformation in the facility.

5. Take extra caution in small facilities. Small facilities may be more prone to these unsafe practices than large hospitals, Ms. Pugliese says. She says this may be because small clinics are staffed by a limited number of people, who pass information from one person to the next with limited oversight from a bureaucratic structure.

"When you work in a hospital, you really have a lot of other people watching you," she says. "In non-hospitals, there's a greater opportunity for improper practices to go on for a long time. It's the attitude that, 'This is the way they showed me, and this is how I'm doing it. Everybody does it that way.'"

She says this means education in small facilities is even more important. You don't want your long-time OR nurse passing on misinformation about unsafe practices to her colleagues because she simply doesn't understand the rules — and is the only source of education for new workers.

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