July 2015

Reflection on FDA Guidance on Filliing of Medication Vials

Steve Langan, director of HONOReform, shares recent FDA guidance on medication vials
Steve Langan, director of HONOReform, shares recent FDA guidance on medication vials

Thank you to Dr. Tom McKnight for sharing his experience last week in the blog post titled “Summertime and Safe Injections.” From what we have learned from nurses, techs, office administration and nursing students, some providers and others insist, subtly or directly, on not “wasting” any medication. Sadly, regrettably, using medication from single-dose vials more than one time is a widespread practice, and so is the misuse of the multi-dose vial.

We are grateful to FDA for this clear response on overfilling vials. It’s a helpful document to include in HONOReform’s ongoing advocacy work. As they say, it takes a village to raise a child; we are finding that it takes a village to raise a body of knowledge regarding safe injections. FDA and CDC and others have taken a clear stand on virtually all aspects of injection safety.

We encourage all health care workers to join us. We invite all patients to always ask for a safe injection. And we thank Tom McKnight for demonstrating that patient safety must be, in all settings, the uppermost concern.

Summertime and Safe Injections

Dr Tom McKnight is a co-founder of HONOReform and a family physician in Fremont, NE
Dr Tom McKnight is a co-founder of HONOReform and a family physician in Fremont, NE

Everyone agrees that summer is meant for fun, especially fun in the great outdoors. But sometimes injuries happen in the pursuit of fun, resulting in a trip to the Emergency Department.

I practice medicine in a town that is near a state park. Thousands of people flock there in the summertime, boating and swimming in the pretty blue lakes. When I first began my family medicine practice 30+ years ago, our hospital did not have Emergency Room physicians. The primary care physicians on staff were called in to care for patients who needed to be seen. I wish I would have kept track of how many times I trekked to the ER to stitch up a camper from the state lakes, who cut himself on a piece of glass or during a fall while waterskiing. I think it would be interesting to know.

Sometimes the nurse who was helping me would bring out a vial of lidocaine that had been used for the previous patient. I wouldn’t know if the previous healthcare provider had used safe injection practices or if they had reused needles and syringes to access the vial, thus contaminating it. The vial was usually not labeled, either. I would direct the nurse to throw out the previously used vial, and use a new vial. Some of the nurses thought this was unnecessary and it took some time and thoughtful discussion before we all agreed on designating a vial for each patient.

With so many people at the lakes, we might have many emergencies at once. It was not unusual to have 10 people waiting to be seen when an ambulance would roar in and all the doctors and nurses would drop what they were doing and rush to participate in the code. The pace was stressful and fast – a combination that can lead to error. We all had to be on our toes at all times to make sure that every action was safe for the patients as well as the staff. During a code, many injections are given very quickly. With several healthcare providers standing close together around the patient, working rapid-fire, there was the possibility of accidental needlesticks and improper disposal of sharps.

Not long ago I myself was a patient at the ER. I was stung many times while harvesting honey from our beehives – the bees were not going to give up the result of their hard work without a fight! I swelled up like a balloon, and felt my throat closing. We rushed to the ER where I was given IV’s to reduce the swelling. I was so glad that the staff had had had the thoughtful discussions about injection safety. They saved my life that day, and protected me from any disease that could have been transmitted through unsafe injections.

Our hospital now has emergency room physicians on staff. I am grateful, and not just because it frees me from being called in at any time of the day or night. I am grateful for their knowledge of and committment to injection safety, because we are all patients at some time. Although I have given up beekeeping, I haven’t given up waterskiing; I just might need to be stitched up after a fall!

Methodist Monday: “You need to speak up when you see someting unsafe”

Scott J. Greenwood is a Junior Level Nursing Student at Nebraska Methodist College
Scott J. Greenwood is a Junior Level Nursing Student at Nebraska Methodist College

Unsafe injection practices aren’t something I thought about until I read Dr. Evelyn McKnight’s book. I was under the impression that these sorts of things didn’t happen in the U. S. in this day and age. Now that I know how easily these things do happen, I will always pay extra attention when giving an injection to keep my patient safe.

Hearing her experience also made it clear that as a nurse, you need to speak up when you see something unsafe. It doesn’t matter who the person is. If I were doing something unsafe, even unintentionally, I would expect somebody to step in and to correct me.

I’m glad I was given the opportunity to hear Evelyn speak. It drove home the point as to why safe injection practices are so important.

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