- The Joint Commission has reversed its position on the use of texting by physicians to transmit orders.
- Most common questions and answers according to the Centers for Disease Control and Prevention regarding medication administration and infection control.
Joint Commission Revokes Texting Physician Orders as Safe Option
The Joint Commission has worked with the Centers for Medicare & Medicaid Services (CMS) to develop guidelines for text-message-based orders to ensure consistency with Medicare’s Conditions of Participation. Read more.
Medication Administration and Infection Control
When the CAP Risk Management team is out visiting physician offices the specialists are often asked questions relating to safe administration of medications and proper infection control techniques. The following are answers to the most common questions and answers according to the Centers for Disease Control and Prevention (CDC).
Is it acceptable to use the same syringe to give an injection to more than one patient if I change the needle between patients?
No. Once they are used, the syringe and needle are both contaminated and must be discarded. Use a new sterile syringe and needle for each patient.
Is it acceptable to reuse a syringe and/or needle to enter a medication vial for the same patient if the medication vial and the syringe will be discarded at the end of the procedure and not used for subsequent patients?
The safest practice is to always enter a medication vial with a sterile needle and sterile syringe, even when obtaining additional doses of medication for the same patient. This adds an extra layer of safety in case, for some reason, the medication vial is not discarded at the end of the procedure as it should be and is inadvertently used on a subsequent patient.
Is it acceptable to use the same syringe and/or needle to administer multiple injections to the same patient (e.g., in the case of numbing a large area of skin or to provide incremental doses of intravenous medication)?
The safest practice is for a syringe and needle to be used only once to administer a medication to a single patient, after which the syringe and needle should be discarded. This practice prevents inadvertent reuse of the syringe and protects healthcare personnel from harms such as needlestick injuries.
What is a single-dose or single-use vial?
A single-dose or single-use vial is a vial of liquid medication intended for parenteral administration (injection or infusion) that is meant for use in a single patient for a single case/procedure/injection. Single-dose or single-use vials are labeled as such by the manufacturer and typically lack an antimicrobial preservative.
Can single-dose or single-use vials be used for more than one patient?
No. Vials that are labeled as single-dose or single-use should be used for a single patient and single case/procedure/injection. There have been multiple outbreaks resulting from healthcare personnel using single-dose or single-use vials for multiple patients. Even if a single-dose or single-use vial appears to contain multiple doses or contains more medication than is needed for a single patient, that vial should not be used for more than one patient nor stored for future use on the same patient.
How many times may individual single-dose or single-use vials be entered for a single patient?
The safest practice is to enter a single-dose or single-use vial only once so as to prevent inadvertent contamination of the vial and infection transmission. Single-dose or single-use vials should be used for a single patient and a single case/procedure/injection. Therefore, they should require only a single entry into the vial.
If the single-dose or single-use vial will be entered more than once for a single patient as part of a single procedure, it should be with a new needle and new syringe, and the vial must be discarded at the end of the procedure and not stored for future use.
Is it acceptable to combine (pool) leftover medication from single-dose or single-use vials?
No. Do not combine (pool) leftover contents of single-dose or single-use vials or store single-dose or single-use vials for later use. Single-dose or single-use vials are intended for use on a single patient for a single case/procedure. There have been outbreaks resulting from pooling of contents of single-dose or single-use vials and or storage of contents for future use.
When should single-dose or single-use vials be discarded?
Medication vials should always be discarded whenever sterility is compromised or questionable. In addition, the following recommendations are made for handling of single-dose or single-use vials:
If a single-dose or single-use vial has been opened or accessed (e.g., needle-punctured) the vial should be discarded according to the time the manufacturer specifies for the opened vial or at the end of the case/procedure for which it is being used, whichever comes first. It should not be stored for future use.
If a single-dose or single-use vial has not been opened or accessed (e.g., needle-punctured), it should be discarded according to the manufacturer’s expiration date.
References
CDC
Submitted by Sue Jones, CPHRM
Senior Risk Management and Patient Safety Specialist
This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.