Medication safety is the responsibility of all paramedics and EMRs/FRs. Follow safe medication handling procedures at all times.
Principles of Medication Safety and Administration
Medication errors are the leading cause of patient safety incidents in health care and are preventable through close compliance with a set of best practices for drawing up, administering, and storing pharmaceutical products. The 'six rights' encapsulate the primary basis for these practices:
Right patient: does the patient meet the indications for the medication based on current clinical practice guidelines?
Right medication: is the correct medication being prepared and has the identity of the medication been checked at each step of the preparation process and prior to administration?
Right dose: have dosage calculations been verified and confirmed?
Right time: is this the correct time to administer the medication based on the treatment plan that has been developed?
Right route: is the proposed route of administration correct for both the medication and the clinical indication?
Right documentation: has the administration of the medication been entered into the ePCR?
Failure to adhere to these practices can result in serious and potentially fatal adverse events.
Paramedics and EMRs/FRs must be particularly vigilant with respect to medication identity, dosing strategies, and routes of administration. Errors in medication administration must be documented on the ePCR and reported through the Patient Safety Learning System.
Visually inspect all medications prior to administration, including the label. Do not administer medication that is cloudy, beyond its expiry date, or where the appropriate diluent is not available.
If a medication is drawn into a syringe (or otherwise removed from its packaging), paramedics and EMRs/FRs must ensure that the syringe is clearly and unambiguously labeled with the medication and its concentration.
Labels for naloxone, dimenhyDRINATE, diphenhydrAMINE, MIDAZOLam, EPINEPHrine, morphine, adenosine, atropine, amiodarone, rocuronium, fentaNYL, succinylcholine, phenylephrine, magnesium sulfate, ketAMINE, lidocaine, and propofol are available and must be used. Blank labels can be filled out and used in those instances where a pre-printed label is not available.
When preparing a medication for infusion, paramedics must affix a label to the bag of fluid indicating the name of the medication, as well as the final concentration, prior to connecting the solution to an intravenous line.
Paramedics and EMRs/FRs must confirm the patient’s allergy status prior to administering any medication.
Epinephrine holds unique risks for patients. Medication errors involving epinephrine can be fatal. Epinephrine vials must be segregated from other medications and stored in specially marked containers in medical kits and ambulance cabinets.
Do not remove medication from outer packaging prior to use.
Do not use preloaded saline syringes to dilute medications and do not store diluted medications in a preloaded saline syringe. These syringes are intended for flushing intravenous lines only.
Never give the contents of a syringe that is not labeled unless it was immediately drawn from an ampoule or vial.
Reconciliation of controlled and targeted substances must be completed in accordance with BCEHS policy.
Misasi P, et al. Medication safety in emergency medical services: approaching an evidence-based method of verification to reduce errors. 2019. [Link]
Canadian Patient Safety Institute. Patient safety in emergency medical services: Advancing and aligning the culture of patient safety in EMS. 2010. [Link]