Check Expiration Dates Prior to Administration

PURPOSE: The purpose of this policy is to provide guidelines for the safe administration and storage of injection medications, eye drops and solutions POLICY: The following recommendations will apply to the use of needles and syringes, cannulae that replace needles, single-dose and multi-dose vials and, where applicable, intravenous delivery systems and eye drops.  Perform hand hygiene prior to accessing medications and solutions and immediately before drawing up or administering the medication  Check expiration dates prior to administration  Use aseptic technique to avoid contamination of sterile injection equipment; the stopper on vials or IV tubing ports or connectors shall be scrubbed with alcohol (or other products if appropriate) prior to each entry  Many eye ointments and eye drops are now available in single-dose or smaller sized containers. If using multi-dose eye drops: o The bottle tip should not come into direct contact with the patient's tears or conjunctiva; if the tip does touch the patient, the bottle must be discarded o Discard the bottle when used on patient with an infectious eye process  A single needle and single syringe are used for a single patient o Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed o Needles, cannulae and syringes are sterile, single-use items; they should not be reused for another patient or to access a medication or solution that might be used for a subsequent patient o Medication vials are always entered into with a new needle and new syringe regardless of whether that medication vial is dedicated for that patient only and is being used for the same procedure  Use fluid infusion and administration sets (e.g., IV bags, tubing and connectors) for one patient only and dispose appropriately after use o Consider a syringe or needle/cannula contaminated once it has been used to enter or connect to a patient's IV infusion bag or administration set o Spike IV or irrigation bags/containers no sooner than one hour prior to initiation of administration o Do not use bags or bottles of IV solution as a common source of supply for multiple patients (e.g., saline flushes)  Use single-dose or single patient use vials for medications whenever possible o Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use

5.01 USE, HANDLING, AND STORAGE OF MEDICATION, EYE DROPS & SOLUTIONS POLICY 1 o Discard vials or solutions labeled with "single patient use" or "single use" or "preservative free" after use on single patient o Manufactured pre-filled syringes that may have enough medication for more than one patient must still only be used for one patient and discarded at the end of the procedure  Multi-dose injectable vials are only used for one patient, whenever possible o If multi-dose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile o Multi-dose containers (e.g., vials, eye drops) are formulated for removal of portions on multiple occasions because they contain antimicrobial preservatives. The beyond-use date after initially entering or opening (e.g., needle-punctured) multi- dose containers is 28 days, unless a shorter timeframe is otherwise specified by the manufacturer. o Do not keep multi-dose vials in the immediate patient treatment area; store in accordance with the manufacturer's recommendations and discard if sterility is compromised or questionable  Draw up medication just prior to the procedure o Do not draw up for multiple patients o Pre-drawn medications must be labeled properly with the time of the draw, initials of the person drawing up the medication, name of the medication, strength of the medication and the expiration date, if the manufacturer has not printed it on the vial  Sharps should be disposed of in a puncture-resistant sharps container  Never store or carry medications in personal clothing or pockets  If IV fluids are placed in a warmer for patient comfort there must be documentation from the specific IV solution company as to how long the solution can remain in the warmer. If more than one company is involved, there must be documentation from each company. A dating system should be implemented to monitor how long each container or bag of solution has been in the warmer and its discard date.

REFERENCES American Society of Cataract and Refractive Surgery and the American Society of Ophthalmic Registered Nurses. Recommended Practices for Cleaning and Sterilizing Intraocular Surgical Instruments. February 16, 2007. American Academy of Ophthalmology. (2009). Infection Prevention in Eye Care Services and Operating Areas and Operating Rooms. Dolan, S.A., Felizardo, G., Barnes, S., Cox, T.R., Patrick, M., Ward, K.S., & Arias, K.M. (2010). APIC Position Paper: Safe Injection, Infusion, and Medication Vial Practices in Healthcare. American Journal of Infection Control, 38(3), 167-72. Siegel, J.D., Rhinehart, E., Jackson, M., Chiarello, L., & the Healthcare Infection Control Practices Advisory. (2007). 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Atlanta, Georgia: Centers for Disease Control & Prevention. One Needle, One Syringe, Only One Time. Centers for Disease Control & Prevention, Safe Injection Practices Coalition.

5.01 USE, HANDLING, AND STORAGE OF MEDICATION, EYE DROPS & SOLUTIONS POLICY 2 DISCLAIMER: All data and information provided by the Oregon Patient Safety Commission is for informational purposes only. The Oregon Patient Safety Commission makes no representations that the patient safety recommendations will protect you from litigation or regulatory action if the recommendations are followed. The Oregon Patient Safety Commission is not liable for any errors, omissions, losses, injuries, or damages arising from the use of these recommendations.

5.01 USE, HANDLING, AND STORAGE OF MEDICATION, EYE DROPS & SOLUTIONS POLICY 3