Medication
Safety
Today
Issue 44 The Northern Ireland Medicines Governance Team Newsletter August 2013
Another Shot Hyperkalaemia Kits In February 2012, Medication Safety Today highlighted that doses of caffeine were to be An insulin-glucose infusion is a safe, commonly expressed as caffeine base in accordance with BNF used treatment for hyperkalaemia, defined as for children. The latest edition of the BNF newsletter serum or plasma potassium greater than or equal to (May 2013) has advised: 5.5mmol/L. However serious problems may arise if too much insulin is administered in error. Expression of caffeine doses Hyperkalaemia kits and treatment guidelines are Licensed preparations of both caffeine citrate and available in all trusts. caffeine base are available for the treatment of neonatal apnoea. The MHRA have decided that all An audit across all acute adult wards in Northern licensed preparations should be labelled as caffeine Ireland evaluated the availability and accessibility of citrate, and have requested that the manufacturers hyperkalaemia kits. Its key findings were: change the labelling of their products accordingly. This change should take place during 2013. Trusts should ensure continued availability In response to this, the caffeine monographs in BNF of hyperkalaemia kits and that staff continue for children have been reviewed, and now only one monograph for caffeine citrate is included, with to be informed of the need to use them. caffeine doses expressed in terms of caffeine citrate. Staff should ensure that once the seal on a To minimise confusion and the risk of dosing errors kit has been broken, that it is returned to during the changeover period: pharmacy as soon as possible for replacement. Always state dose in terms of caffeine citrate when prescribing caffeine. For Safety tips further information, see Caffeine citrate. Staff should ensure that they are aware of Find out what is happening in your trust to the exact location of the hyperkalaemia kit implement this change. on the ward that they are working on and where to find the treatment guidelines.
Phenytoin liquid Always remember that the dose of
soluble insulin to treat hyperkalaemia is The licensed strength of phenytoin suspension is 10 UNITS and the dose must be second 30mg/5ml. However there is also an additional checked by the senior nurse on duty. strength available as a ‘Special’ which is 90mg/5ml.
Safety tips Be aware of this additional strength of If you have any comments on this newsletter, please phenytoin liquid which may not be routinely contact Sharon O’Donnell, Medicines Governance stocked. pharmacist on 028 90638129 at the Royal Hospital or by e-mail at [email protected] Always check the strength of all liquids and Further copies of this newsletter can be viewed at suspensions carefully when prescribing, www.medicinesgovernanceteam.hscni.net or on your dispensing and administering. Trust intranet.
Paracetamol – still a pain Switchover
Medication incidents continue to be reported where The regional contract for prolonged release the incorrect dose of paracetamol is prescribed and oxycodone tablets has changed brands from administered. These have occurred when OxyContin® to Longtec®. Longtec® is licensed for the paracetamol is prescribed for both oral and IV treatment of moderate to severe pain in patients administration. For example: with cancer and post-operative pain and for the IV paracetamol 1g 4-6 hourly when required treatment of severe pain requiring the use of a prescribed for a patient weighing 40 kg. Dose strong opioid and is bioequivalent to OxyContin® reduction is required for weight <50 kg and the tablets. dose should have been 600mg. A twelve year old child weighing 28kg prescribed oral paracetamol 750mg. Dose should have been 420mg.
Safety tips Longtec® is colour coded to help differentiate The most recent weight of the patient must be between different strengths and the colours match documented on the Kardex. that of OxyContin® to avoid confusion when patients Ensure that the correct paracetamol dose for switch from OxyContin® to Longtec®. the weight of the patient is prescribed. Check a current BNF or the Summary of Product Safety Tips Characteristics. Brand names must be used for oral opiates Double check any calculations to help differentiate between different For further information related to IV paracetamol, preparations. ® please see a previous Medication Safety Today at OxyNorm will remain the product of choice http://www.medicinesgovernanceteam.hscni.net/news for the immediate release formulation of letters/newsletters/MST%2035.pdf or oxycodone. http://www.medicinesgovernanceteam.hscni.net/safet Look out for notification of the changeover in y/Safety%20memo%2015%20- your Trust. %20IV%20Paracetamol.pdf Inform the patient so they are aware that Longtec® replaces OxyContin® and ensure they don’t take both when they get home. Same difference All communication to primary care must specify that the patient has been switched to ® Incidents have been reported where medicines with Longtec so patients aren’t switched back or similar names and the same dose/strength have prescribed both. been mixed up when prescribing, dispensing or administering. For example: Drop, drop, drop…
Amitriptyline 10mg Amlodipine 10mg Citalopram is available as both tablets and oral Atenolol 100mg Allopurinol 100mg drops. Medication incidents have been reported where an incorrect dose of citalopram drops has Clonazepam 5mg Clobazam 5mg been prescribed or administered. Citalopram oral drops come in a strength of 40mg/ml, four drops Hydralazine 50mg Hydroxyzine 50mg (8mg) is equivalent to a 10mg citalopram tablet. Dose instructions for citalopram drops can be found in the current BNF. Pantoprazole 40mg Propranolol 40mg Remember
Safety tips When prescribing citalopram oral drops, specify the number of drops needed to Be aware that, when handwritten, some make up the required dose in brackets medicine names may be confused with a medicine with a similar name. beside the dose in mg.
Print medicine names and write Only use the dropper provided when doses/strengths legibly. administering.