1.3 Epidural Drug Delivery

Question 1

List Potential Critical Incidents that can occur with Epidural drug delivery

Answer 1

1. Epidural drug delivered via wrong route
   - IV / IM / IT
2. IV or IM drug delivered via epidural route
3. Wrong epidural drug - lido not bupiv
4. Incorrect doses
   Volume + concentration
5. Delivery device incorrectly primed / set up / programme
6. Missed doses epidural drug
7. Error in drug supply
   - box / vial incorrectly labelled
8. Expired drug delivered
9. Drug Not stored correctly
   fentanyl - MDA press

Question 2

Prevention / Minimization of incidents of epidural drug delivery incidence

Answer 2

1. Labelling
2. Doses and Concentrations
3. Storage
4. Admin sets
5. Epidural delivery devices
6. Staff training

Question 3

1. Labelling

Answer 3

Clear labelling on:
packaging
Infusion bags
& syringes
FOR EPIDURAL USE ONLY

Different coloured and designed bags syrings and infusion lines
- Yellow

Suggested incompatibility between epidural bags and IV infusion giving sets

Question 4

2. Doses and concentrations

Answer 4

1. Limit the range of doses or concentrations available
   epidural route admin
   avoid potential dose error
2. Ensure all doses / infusion / concentrations
   check second qualified person
3. Regular annual audit
   epidural admin
   adherence to national and local guidance
4. Minimise complicated ep drug prep
   Ready mixed bags
   .125% bupiv w/ 2mcg/ml fentanyl - 500ml bag

Question 5

3. Storage

Answer 5

Store all drug syringes / bags / infusions
separate to IV drugs

Confirm pharmacy sending correct epidural bag to correct clinical area
Syringe v infusion bags

Question 6

4. Admin sets

Answer 6

Designated epidural giving sets
ID clearly w/ labelling - EPIDURAL
colour - yellow

Ensure clear procedure
guide clinicians on set up and labelling
epidural drug admin

Question 7

5. Epidural Delivery Devices

Answer 7

Delivery devices clearly labelled
EPIDURAL USE ONLY

Clearly distinguishable from IV delivery devices
eg syntocin infusion

Standardized epidural delivery
preset codes
epidural protocols relevant to area

Question 8

6. Staff Training

Answer 8

1. All staff:
   Prep/ Administration/ Clinical care patients
   receiving epidural drugs
   undergo formal training in
   epidural drug prep / delivery / monitoring
2. Inexperienced staff - competencies signed off
   supervision senior staff
   before solo supervision w/ epidural drug delivery allowed
3. Staff should be trained in recognition and management of LAST