May 25, 2010: Neuromuscular Blocking Agents: Another Manufacturer Changes Labelling and Packaging to Increase Safety
In 2006, ISMP Canada described a collaborative initiative involving clinical experts and pharmaceutical manufacturers of neuromuscular blocking agents (in alphabetical order: Abbott Laboratories, Hospira Healthcare Corporation, Organon Canada [now Schering-Plough Canada Inc., a subsidiary of Merck], and Sandoz Canada Inc.). The intent of the initiative was to identify opportunities to reduce the risk of accidental administration of neuromuscular blocking agents. Medication incidents involving inadvertent administration of these agents have been described in previous issues of the ISMP Canada Safety Bulletin.The initiative led to an agreement on potential strategies for improving the labelling and packaging of neuromuscular blocking agents, within manufacturers’ limitations. Several manufacturers (Abbott, Hospira, and Sandoz) made changes immediately or shortly thereafter. The distinct labelling and packaging features used for neuromuscular blocking agents have since been reported to have prevented a medication error.
This type of collaboration between industry and experts, along with work in healthcare facilities to implement safeguards within their medication-use systems, represents a multipronged approach to improving safety with neuromuscular blocking agents. The Operating Room Medication Safety Checklist available from ISMP Canada provides specific guidance for managing the storage and use of neuromuscular blocking agents.
ISMP Canada is pleased to report that Merck recently changed the labelling and packaging of the neuromuscular blocking agent rocuronium (Zemuron). In addition to continuing to provide a peel-off label that can be added to a parenteral syringe, safety features now include a warning on the vial cap and a bar code, as illustrated in Figures 1 and 2.
References
1. Neuromuscular blocking agent labelling and packaging initiative. ISMP Can Saf Bull. 2006 Apr 25 [cited 2010 May 10];6(2):2. Available from: http://www.ismp-canada.org/download/safetyBulletins/ISMPCSB2006-02PotassiumPhosphates.pdf
2. Neuromuscular blocking agents – time for action. ISMP Can Saf Bull. 2002 Dec [cited 2010 May 10];2(12):1-2. Available from: http://www.ismp-canada.org/download/safetyBulletins/ismpcsb0212.pdf
3. “Paralyzing” mix-ups in the operating room: opportunity to improve safety with neuromuscular blockers. ISMP Can Saf Bull. 2004 Jul [cited 2010 May 10];4(7):1-2. Available from: http://www.ismp-canada.org/download/safetyBulletins/ISMPCSB2004-07.pdf
4. Enhanced labelling of neuromuscular blocking agents makes a difference. ISMP Can Saf Bull. 2007 Nov 13 [cited 2010 May 18];7(5):3. Available from: http://www.ismp-canada.org/download/safetyBulletins/ISMPCSB2007-05Fentanyl.pdf
5. Operating room medication safety checklist. Toronto (ON): Institute for Safe Medication Practices Canada; 2009. See Section 3: “Communication of medication orders and other drug information”, and Section 5: “Medication standardization, storage, and distribution”.
