To the Editor:
It has come to my attention that many anesthesia professionals do not follow established standards when preparing medications from glass ampoules. The American Society of Health-System Pharmacists and the Infusion Nurses Society are 2 health care organizations that have guidelines for standards of practice regarding filter needle use with glass ampoules. These organizations base their guidelines upon recommendations from the United States Pharmacopeia (USP) Chapter <797>: Pharmaceutical Compounding- Sterile Preparations. The purpose of USP 797, in part, is to prevent patient harm resulting from unintended physical (glass) contaminants and provide minimum quality and practice standards based upon recent scientific evidence. The Joint Commission, formerly the Joint Commission on Accreditation of Healthcare Organizations, also considers USP ” best” clinical practice. Therefore, anesthesia providers should follow established guidelines for standards of practice.
The following key points are noted based upon my review of the literature:
- Glass particle contamination (GPC) of medication may occur when opening ampoules
- GPC has the potential to cause patient harm when injected into the patient
- Filter needle use with ampoules can reduce the risk of GPC
- Pharmacy and nursing have established standards of practice to improve patient safety by reducing GPC when drawing medications from ampoules
- Some Anesthesia professionals that regularly use ampoules do not routinely use filter needles when preparing medications from ampoules
In summary, anesthesia professionals should be dedicated to providing to the public the safest anesthesia services possible based on current science supporting best practices. This includes considering established guidelines and standards from pharmacy and nursing health care organizations when preparing medications from ampoules. Blunt filter needles or filter straws with a 5 micron filter should be available and used each and every time a medication is aspirated from a glass ampoule to reduce glass particle contamination Such action will promote patient safety and reduce the risk of patient harm.
Debran L. Harmon, CRNA, MSN, MAT, MSH, ARNP Jacksonville, Florida