Update on “Examples of risk assessments of injectable medicine products prepared in clinical areas” published by the Joint NHS pharmacy technical services groups in 2007

This is not intended to represent a comprehensive list of all potential high risk injectables and does not obviate the need for assessment of local practice,

This guidance is intended to assist NHS Trusts to generate their own high risk injectable medicines list for the purposes of implementing the never event policy. Pharmacists are advised to ensure that local risk assessments have been undertaken for the products and miscellaneous groups listed below (if relevant) and any discrepancies in scoring are reviewed.

In this exercise assessment was restricted to routine administration methods for intravenous injections used in the adult setting. These were identified by reviewing risk assessments compiled by Medusa, UCLH, Imperial, Oxford Radcliffe Hospitals and Guys & St Thomas NHS Foundation Trusts and the Pharmaceutical Press, with additional suggestions from members of the working group. The assigned risk levels were agreed through consensus of group members (listed below). Use of injectable medicines in paediatric and neonatal regimens, and by parenteral routes of administration other than IV are not included in the assessment, although the group has included suggested areas of practice in which  additional local assessment may be warranted. Where relevant, the availability of commercially available ready-to-use products is highlighted as a means of reducing risk. Additionally aseptic preparation in pharmacy CIVAS services or as a “special” from an alternative provider should be considered as a method of reducing the risk associated with preparing high-risk products in clinical areas. Therapeutic alternatives to high risk products should also be considered as a method of reducing risk in some clinical settings.