'Call to action' on wrong-route injections in anesthesia

Worldwide changes in catheter system design are urgently needed to prevent serious complications caused by accidental injection of drugs into the wrong location, according to a special editoral in the March issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

David J. Birnbach, MD, MPH, of University of Miami Miller School of Medicine and Charles A. Vincent, PhD, of Imperial College London issue a "call to action" on the long-neglected problem of wrong-route injections in anesthesia. Dr Birnbach comments, "Our goal is to bring a well-known but poorly addressed problem into the light so that world leaders in anesthesiology and patient safety can work together to come up with solutions that can be embraced throughout the world."

Failure to Make Needed Changes Is 'A Seismic Oversight'
The editorial was spurred by continued reports of devastating complications caused by injection of drugs intended for intravenous (IV) use into spine or epidural space (the area surrounding the spinal cord)—or the "even more dangerous" injection of epidural drugs into the general circulation. A recent alert by the U.K. National Patient Safety Agency called for systematic design changes to prevent such wrong-route injections, to be put in place by April, 2011.

"However," Drs Birnbach and Vincent write, "this deadline has passed, the goal has not been met in either the United States or the United Kingdom, and the risk thus continues." They add, "Ignoring this risk is irresponsible, and from a patient safety perspective, a seismic oversight."

Other types of accidental drug administrations have been eliminated by designing systems that make it difficult or impossible to inject the wrong type of drug into the wrong type of catheter—"to prevent the proverbial round peg from being placed in the square hole," the authors write. Although such systems have been proposed for epidural or spinal catheters, they have yet to be developed or evaluated.

"[T]he larger problem is that there has not been the necessary consensus, pressure, and motivation in the United States or Europe to address the problem," according to Birnbach and Vincent. While progress has been "glacially slow," at least some steps have been made in the United Kingdom—in contrast to the United States, where little or no action has been taken.

Global Problem Demands a 'Global Solution'
The authors are noted leaders in patient safety from opposite sides of the Atlantic who represent different approaches: Dr. Vincent is a PhD scientist focusing on systems errors while Dr. Dr Birnbach is an MD who looks at clinical errors. They emphasize that international cooperation will be needed to reach the essential goal of worldwide standardization.

"In this global world in which we live, we need to come up with a global solution," says Dr Birnbach. The editorial was timed to appear in advance of the upcoming World Congress of Anaesthesiologists in Buenos Aires, where the authors hope the topic of wrong-route injections will be at the "front and center of discussions."

Through organizations like the Anesthesia Patient Safety Foundation, anesthesiologists have been pioneers in efforts to improve patient safety and quality of care. "What is essential at this point," Birnbach and Vincent conclude, "is that all concerned parties must meet, that a consensus regarding the most effective solution be developed, and that all epidural and spinal kits use this new safer alternative to epidural catheter design."