Pharmaceutical Risks of Injection Therapy: The Role of a Nurse

Nurse-administered injections come with a special set of risks, including such pharmaceutical factors as preparation of medicinal products in a vial prior to administration, conditions of their further storage, labelling of packages, and the need for personalised dosing of solutions for injection.
The aim of the study was to analyse Russian state standard GOST R 52623.4-2015 and identify factors contributing to the risk of nursing staff’s errors in preparing, storing, and labelling of medicinal products for injection.
Materials and methods. The authors analysed GOST R 52623.4-2015 Technologies for Performing Simple Medical Services of Invasive Interventions and assessed the identified risks by the FMEA method (failure modes and effects analysis).
Results. The authors identified pharmaceutical risks, causes, and sources of hazardous events that occur during administration of parenteral medicinal products. The standard does not instruct readers on the order of mixing medicines in a vial and on choosing solvents for lyophilised powders. There is no labelling procedure for opened vials in the document. It does not stress the inadmissibility of pre-administration storage of a syringe/dropper with a medicinal product. The document lacks information on the need to warm the aqueous solutions that are stored in a refrigerator and/or administered at a temperature of 36–38 °С as per the package leaflet. The standard does not include a procedure for visual estimation of the volume of a solution drawn into a syringe for individual dosing of medicinal products to children. According to the FMEA risk assessment, the highest risks are posed by the order of mixing medicines in a vial and by the storage of syringes/droppers prior to administration to patients.
Conclusions. To improve the safety of injection therapy, it is necessary to supplement the state standard with the identified causes of hazardous events. Nursing staff in medical organisations would benefit from in-house training on prevention of pharmaceutical risks carried out with the help of specialists in pharmaceutics and from wider involvement in discussing pharmacotherapy errors.

1. Glushkova EV, Brazhnikov AYu, Kamenskaya AYu, Repetyuk AD, Polybin RV. Assessing the conditions for the occurrence of unintentional injections among nurses and the prospects for the use of safe devices. Epidemiology and Vaccinal Prevention. 2022;21(2):83–90 (In Russ.). https://doi.org/10.31631/2073-3046-2022-21-2-83-90

2. Chikina OG, Sultanova EB, Rumak YuS, Sycheva NE, Abramova MV. Ways of managing the epidemiological risks of nursing manipulations. Chief Nurse. 2016;5(6):14–29 (In Russ.).

3. Westbrook JI, Rob MI, Woods A, Parry D. Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ Qual Saf. 2011;20(12):1027–34. https://doi.org/10.1136/bmjqs-2011-000089

4. Kondratova NV. Application of FMEA analysis for medication risk management in a multidisciplinary hospital. Eurasian Union of Scientists. 2015; 5–5(14):41–2 (In Russ.).

5. Doronina VN. Complications during injection of medicines. Bulletin of Medical Internet Conferences. 2015;5(6):964 (In Russ.).

6. Kuprina SN, Kononova IN, Prokudina OA. The role of a nurse in preventing post-injection complications. In: Conference proceedings “Science and education: domestic and foreign experience”. Belgorod; 2018. P. 319–23 (In Russ.).

7. Lazareva NB, Rebrova EV, Ryazanova AYu. Current issues of drug-drug interactions in novel coronavirus infection (COVID-19) therapy. Practical Pulmonology. 2020;(1):96–103 (In Russ.).

8. Sychev DA, Chernyaeva MS, Ostroumova OD. Genetic risk factors for adverse drug reactions. Safety and Risk of Pharmacotherapy. 2022;10(1):48–64 (In Russ.). https://doi.org/10.30895/2312-7821-2022-10-1-48-64

9. Egorova SN, Abdullina YuA. Completeness of the use of packaging of medicines for parenteral use in a children’s hospital: results of a survey of medical workers of surgical departments. Modern Organization of Drug Supply. 2021;8(1):14–21 (In Russ.).

10. Bernatovich OA, Borzunov IV, Popov AA, Shkinder NL. Standard operating procedures as the nursing activities quality and safety assurance system component. Manager Zdravoochranenia. 2020;(3):31–6 (In Russ.).

11. Ryzhova OA, Moroz TL. The evaluation of conditions of storage and application of medications in hospital. Medical Journal of the Russian Federation. 2018;24(1):25–8 (In Russ.). https://doi.org/10.18821/0869-2106-2018-24-1-25-28

12. Gümüş H, Aydinbelge M. Evaluation of effect of warm local anesthetics on pain perception during dental injections in children: a split-mouth randomized clinical trial. Clin Oral Investig. 2020;24(7):2315–19. https://doi.org/10.1007/s00784-019-03086-6

13. Hogan ME, van der Vaart S, Perampaladas K, Machado M, Einarson TR, Taddio A. Systematic review and meta-analysis of the effect of warming local anesthetics on injection pain. Ann Emerg Med. 2011;58(1):86–98. https://doi.org/10.1016/j.annemergmed.2010.12.001

14. Voronchikhin SG, Tuev MA. A device for warming solutions in transfusion-infusion therapy. Biomedical Engineering. 2022;(2):7–10 (In Russ.). https://doi.org/10.1007/s10527-022-10173-8

15. Sid’ EV, Goldovsky BM, Medvedev VP, Potapov SA, Mozhayskaya NV, Yurchak YuV, Filimonova IV. Correction of energy and structural deficiency by thermal regulation with warm infusion solutions in critical situations. Emergency Medicine. 2014;(7):173–4 (In Russ.).

16. Rashed AN, Tomlin S. Evaluation of the current practice of delivering intravenous opioids infusions in a UK paediatric hospital. Arch Dis Child. 2016;101(9):e2. https://doi.org/10.1136/archdischild-2016-311535.28

17. Kovalskaya GN, Zhukova DYa, Mikhalevich EN. Interaction of medicines for injections and infusions. Siberian Medical Review. 2018;6(114):12–21 (In Russ.). https://doi.org/10.20333/2500136-2018-6-12-21

18. Jessurun JG, Hunfeld NGM, van Rosmalen J, van Dijk M, van den Bemt PMLA. Prevalence and determinants of intravenous admixture preparation errors: a prospective observational study in a university hospital. Int J Clin Pharm. 2022;44(1):44–52. https://doi.org/10.1007/s11096-021-01310-6

19. Zakharova EN, Kovaleva IP. The formation of risk management mechanisms in the medical organisations. Bulletin of the Adyghe State University. Series 5: Economics. 2017;(1):108–15 (In Russ.).

20. Rutledge DN, Retrosi T, Ostrowski G. Barriers to medication error reporting among hospital nurses. J Clin Nurs. 2018;27(9–10):1941–9. https://doi.org/10.1111/jocn.14335

21. Dirik HF, Samur M, Seren Intepeler S, Hewison A. Nurses’ identification and reporting of medication errors. J Clin Nurs. 2019;28(5–6):931–8. https://doi.org/10.1111/jocn.14716