Pharmaceutical Risks of Injection Therapy: The Role of a Nurse

Abstract

Nurse-administered injections come with a special set of risks, including such pharmaceutical factors as preparation of medicinal products in a vial prior to administration, conditions of their further storage, labelling of packages, and the need for personalised dosing of solutions for injection.The aim of the study was to analyse Russian state standard GOST R 52623.4-2015 and identify factors contributing to the risk of nursing staff’s errors in preparing, storing, and labelling of medicinal products for injection.Materials and methods. The authors analysed GOST R 52623.4-2015 Technologies for Performing Simple Medical Services of Invasive Interventions and assessed the identified risks by the FMEA method (failure modes and effects analysis).Results. The authors identified pharmaceutical risks, causes, and sources of hazardous events that occur during administration of parenteral medicinal products. The standard does not instruct readers on the order of mixing medicines in a vial and on choosing solvents for lyophilised powders. There is no labelling procedure for opened vials in the document. It does not stress the inadmissibility of pre-administration storage of a syringe/dropper with a medicinal product. The document lacks information on the need to warm the aqueous solutions that are stored in a refrigerator and/or administered at a temperature of 36–38 °С as per the package leaflet. The standard does not include a procedure for visual estimation of the volume of a solution drawn into a syringe for individual dosing of medicinal products to children. According to the FMEA risk assessment, the highest risks are posed by the order of mixing medicines in a vial and by the storage of syringes/droppers prior to administration to patients.Conclusions. To improve the safety of injection therapy, it is necessary to supplement the state standard with the identified causes of hazardous events. Nursing staff in medical organisations would benefit from in-house training on prevention of pharmaceutical risks carried out with the help of specialists in pharmaceutics and from wider involvement in discussing pharmacotherapy errors.