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Found 167 results
  1. Content Article
    Sodium nitrite has one licensed indication: as an antidote to cyanide poisoning. The Royal College of Emergency Medicine (RCEM) and National Poisons Information Service (NPIS) guideline recommends that it should be “immediately available in the emergency department”. Sodium nitrite can cause significant side effects and is categorised as ‘highly toxic’. Historically, sodium nitrite 30mg/ml has been an unlicensed product supplied in ampoules by ‘Specials’ manufacturers. However a licensed product, supplied as a vial, has been available since 2016. The National Reporting and Learning System (NRLS) identified two incidents where unlicensed sodium nitrite was inadvertently administered to premature babies instead of sodium bicarbonate 4.2%: one very premature baby died soon after this incident occurred and the other died after a period of neonatal intensive care. Hospitals have been given until 6 November to physically check all wards for the wrong drug and to destroy any unlicensed sodium nitrite supplies. This alert is an action for all acute trusts (children and adult).
  2. Content Article
    Do you know your medicines? Do you keep a list? Can you describe and discuss your medicines with healthcare professionals and family when you want to? Keeping track of your medicines and communicating about them can be tricky as there can be so many details to remember. This is especially important if you have a healthcare appointment or are going to hospital.   This "Know Check Ask" campaign website is here to help. Please click on the content below to learn more about taking medicines safely.
  3. Content Article
    This webpage is to provide resources and expertise that will help UK pharmacists at the beginning of their careers to tackle the clinical problems that will confront them throughout their professional lives. This site is aimed at pre-registration and foundation level pharmacists in hospitals.
  4. Content Article
    This YouTube video from nurse, Sophie Pig, aims to give you a better understanding of the 7 rights of medication administration. It is important to remember these 'rights' for every patient you encounter on a drug round.
  5. Content Article
    Out-patient Parenteral Antibiotic Therapy (OPAT) is now a routine part of care in the UK following demonstration that it is safe and effective for patients and OPAT is now being actively promoted as part of the UK government’s stewardship initiatives. NHS North Tees and Hartlepool share their experience of redesigning their OPAT services. See the attachment below for details on the project. 
  6. Content Article
    As part of the Nursing Standard's 'How to' series, Jane Brindley, a senior lecturer in adult nursing, provides a step-wise, practical approach to undertaking intravenous (IV) infusion calculations. The article also explores the evidence base behind medication errors in relation to calculations.
  7. Content Article
    HSIB has identified a significant safety risk posed by the communication and transfer of information between secondary care, primary care and community pharmacy relating to medicines at the time of hospital discharge. A reference event was identified that resulted in a patient inadvertently receiving two anticoagulant medications at the same time, possibly causing an episode of gastrointestinal (digestive tract) bleeding. Increasingly, healthcare facilities in primary and secondary care are introducing digital solutions (electronic prescribing and medicines administration (ePMA) systems) to improve medicines safety. However, analysis of the reference event identified how ePMA systems can create their own risks, risks that will need to be addressed as these systems become more widespread. Other risk factors relating to prescribing and the discharge of the patient, including medicines reconciliation, availability of pharmacy services and weekend working, were identified during the investigation.
  8. Content Article
    Healthcare professionals were made aware of alerts and letters issued about adrenaline auto-injectors in September and October 2019 by the Medicines & Healthcare products Regulatory Agency. This article provides a summary of recent advice issued to healthcare professionals, including information to provide to patients, to support safe use of adrenaline auto-injectors.
  9. Content Article
    The 5th National Audit Project (or NAP5) of the Royal College of Anaesthetists and Association of Anaesthetists was the largest ever study into accidental awareness during general anaesthesia (AAGA). Numerous publications emerged from the project and whereas a comprehensive list of 64 recommendations were made, the full report and associated publications were primarily academic outputs not accessible to all practitioners as a day-to-day ready reference, nor did they provide practical recommendations that individuals could use in their daily practice. The purpose of this publication is to distil and interpret the findings of the 5th National Audit Project into actions that individuals (and organisations) can follow to reduce the risk of accidental awareness. 
  10. Content Article
    The responsibility of anaesthetists in prescribing and administering controlled drugs has extended not only to the recovery room and intensive therapy unit, but also to acute and chronic pain services both in hospital and home care. These guidelines written by the Association of Anaesthetists recommend best practice for the safe preparation, distribution and disposal of controlled drugs to meet current clinical demands in peri-operative care.
  11. Content Article
    A number of associations and societies across the UK have come together to provide guidance on the safe switching of warfarin to direct oral anticoagulants (DOACs). This needs to be undertaken in a phased manner over the 12 week cycle of INR monitoring to protect the supply chain for ALL patients. As highlighted in the guidelines, many patients are not suitable for a switch from warfarin to DOACs and further guidance will be available shortly to support services providing care for these patients.
  12. Content Article
    Rizwana Dudhia shares in the Pharmaceutical Journal how a project she initiated to prevent the prescribing of inappropriate medication improved the quality of life for patients with learning disabilities and autism.
  13. Content Article
    An examination of how humans interact with their environments and each other led this team to question one of its long-standing medication safety practices and change how they work.
  14. Content Article
    Medication safety events with the potential for patient harm do occur in healthcare settings. Pharmacists are regularly tasked with utilizing their medication knowledge to optimize the medication-use process and reduce the likelihood of error. To prepare for these responsibilities in professional practice, it is important to introduce patient safety principles during educational experiences. The Accreditation Council for Pharmacy Education (ACPE) and the American Society of Health-System Pharmacists (ASHP) have set forth accreditation standards focused on the management of medication-use processes to ensure these competencies during pharmacy didactic learning and postgraduate training. The experience described here provides perspective on educational and experiential opportunities across the continuum of pharmacy education, with a focus on a relationship between a college of pharmacy and healthcare system. Various activities, including discussions, medication event reviews, audits, and continuous quality improvement efforts, have provided the experiences to achieve standards for these pharmacy learners. These activities support a culture of safety from early training.
  15. Content Article
    The latest Healthcare Safety Investigation Branch (HSIB) report focuses on the life-threatening risk posed by the accidental misplacement of tubes that deliver food or medication to critically ill patients.
  16. Content Article
    This report describes an adverse incident at Queen's Medical Centre in Nottingham in 2001, when a male patient being treated for leukaemia died after being mistakenly given the chemotherapy drug Vincristine intrathecally (into the spine). Vincristine should be administered intravenously, and accidental intrathecal administration of Vincristine is almost always fatal.
  17. Content Article
    Children born to women who take valproate during pregnancy are at significant risk of birth defects and persistent developmental disorders. As such, it is vital that women and girls are dispensed valproate safely. The General Pharmaceutical Council is reminding all pharmacy professionals of what they must do to ensure women and girls receive the right information about valproate and the risk of birth defects. The update includes
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