This year, the Centers for Disease Control and Prevention’s (CDC) One & Only Campaign turns ten years old. The One & Only Campaign, as you may know, focuses on eliminating unsafe injection practices. In the span of a single decade, healthcare facilities across the country have come a long way in improving patient safety via safe injection practices — but: there is still much work to be done.

Despite the strong progress that’s been made since this campaign first launched, a recently published Mayo Clinic Proceedings study found that, between 2012 and 2018, more than 66,000 patients were notified of possible exposure to blood-borne pathogens as a result of unsafe injection practices.

How does your healthcare facility ensure patient safety and mitigate injection risks? Do you have policies and procedures addressing safe injection practices based on nationally-recognized guidelines? Are you following your policies — and who is guiding monitoring your compliance? AAAHC standards specifically state that written policies must be in place for safe use of injectables and single-use syringes and needles; deficiencies in safe injection practices directly place patients at risk and are a huge potential liability for organizations.

This week, we’ll take a hard look at some of the deficiencies found in surveys, examples of terrible injection practices, and, finally: five ways a consultant pharmacist can help ensure your facility is doing its part to ensure safe injection practices are followed.

What are some of the common survey deficiencies?

When it comes to safe injection practices, could a survey find your ambulatory care facility, or other healthcare facility, deficient in some way? A consultant pharmacist can help you to ensure your healthcare facility doesn’t fall victim to some of the most common deficiencies found in surveys. The following are some of the most common deficiencies:

-Not following the Centers for Disease Control and Prevention (CDC), Association for Professionals in Infection Control and Epidemiology (APIC), or other requirements adopted as policy.

-Not treating a multi-dose medication vial (opened and drawn in a patient treatment area) as a single patient vial.

-Opening, dating, and saving multi-dose vials on anesthesia carts for future use.

-Splitting of single-dose vials for multiple doses.

-Not sterilizing medication vial stoppers before drawing the medication.

-Not labeling (name, dosage, date, time, person drawing the medication, etc.) medication drawn up prior to the procedure.

Examples of poor injection practices (AKA what NOT to do!):

The items on the list below are truly cringe-worthy and needless to say, unsafe! By following best practices, and working with a consultant pharmacist, you can help ensure practices at your facility never end up on this cringe-worthy list.

-Reusing a syringe multiple times on the same patient (i.e. reusing a needle or syringe to withdraw medications multiple times for the same patient).

-“Double-dip” into a multi-dose vial with a needle and syringe already used on another patient.

-Using a bag of intravenous saline as a single source of intravenous flush for multiple patients.

-Diverting injectable pain medication intended for a patient, self-inject, then substituting another liquid to cover the diversion.

-Using the same syringe for more than one patient, even if the needle was changed between patients.

-Using the same fingerstick device (pen) for more than one patient even if the lancet was changed between patients.

-Leaving multi-dose vials in the immediate patient treatment area instead of in a designated medication preparation/storage area.

Five ways a consultant pharmacist can help ensure injection safety:

Policy and procedure: The first step in ensuring safe injection practices is to develop and follow policies and procedures that are based on nationally recognized guidelines such as the CDC, APIC and World Health Organization (WHO). Your consultant pharmacist should be able to guide you in this process.
Frequent audits: Comprehensive medication management audits should be something your consultant pharmacist is expert at. This includes monitoring all systems with audits that extend far beyond product storage and dating (expiration and beyond use dating). Some of the most critical areas revolve around the use of single and multi-dose vials, as well as proper labeling and storage. Remember: audits should be comprehensive with a focus on medication management and patient safety.
Controlled substances: Controlled substances pose multiple risks when it comes to safe injection practices. Not only do we have the same concerns about single and multi-dose vial use protocols, we have the additional potential for diversion, which complicates policies and procedures. You should work with your consultant pharmacist to ensure your controlled substance system is fully reviewed to make sure the process minimizes the risk of diversion starting with ordering and following through to administration or destruction.

One of the common areas of concern is the use of partial doses and wasting. Does your system ensure real-time wasting? There are many areas of concern here and your consultant pharmacist can help you develop a system that is fully compliant.

Drug shortages and compounded drugs: Does your facility use compounded drugs? If so, do you get them from an FDA registered 503B outsourcing facility? According to a 2019 report from the U.S. Department of Health and Human Services Office of Inspector General, about 11% of hospitals get compounded drugs from sources that are not registered with the FDA. This leads to increased risks to your patients and liability for your facility and staff.

When might you use compounded drugs and how does this impact safe injection practices? Sometimes it’s because of drug shortages and other times it’s simply for convenience. Remember that the rules for single and multi-dose vials still apply. Additionally, you may be able to obtain something in single use syringes that would otherwise only be available in multi-dose vials. There are many options to consider, but take steps to protect your patients and let a consultant pharmacist help you do a proper assessment of any outsourcing facility prior to ordering products.

Education: Your consultant pharmacist is perfectly positioned to help you with guidance and resources for staff education. During my visits, I encourage questions from staff members and use the opportunity to provide clarification on any ambiguous or potentially non-compliant practices. It’s not only an opportunity to teach, it’s also an opportunity to learn. I also like to remind my facilities to look at their injection practice policies and procedures at least annually and continually review them with staff and anesthesia providers to ensure everyone is on the same page.

Get a Free Assessment: Need an assessment? As a company, OctariusRx is relentlessly focused on patient safety. We provide comprehensive medication management to ambulatory healthcare facilities, senior care facilities, and pharmacies: our services extend far beyond typical regulatory compliance. If you have any questions, or would like a complimentary assessment of your facility, please contact us today.

Additional Resources:

Safe injection practices checklist

The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centers, senior care facilities and pharmacies We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.