Among the Joint Commission’s 2007 National Patient Safety Goals is improving the safety of using medications. Recognizing the critical role nurses play in medication administration, including those given by syringe, the American Nurses Association (ANA) surveyed nurses on their processes and experiences with injectable medications.

The 2007 Study of Injectable Medication Errors was developed and cosponsored by ANA and Inviro Medical Devices. It surveyed 1,039 nurses on their thoughts on medication safety and their experiences with error or injury, as well as the common causes of medication errors. Specifically, the survey addressed nurses’ opinions on and practices with syringe labeling and its connection to medication safety. The Joint Commission’s National Patient Safety Goals recommend that clinicians “label all medications, medication containers (for example, syringes, medicine cups, basins) or other solutions on and off the sterile field.”

Nancy Hughes, RN, MSN, director of ANA’s Center for Occupational and Environmental Health, explained that the Joint Commission goal was one motivation to conduct the study.

“We wondered what nurses’ views were and what types of problems they had with labeling syringes,” Hughes said. “We got so much from the survey—mostly that we were able to document how concerned nurses are with medication errors. It really underscores how important nurses take medication safety. Patient safety is at the center of what nurses do.”

The survey found that nearly all respondents (97 percent) “worry” about medication errors; 68 percent said errors could be reduced with more consistent syringe labeling. Additional results showed that 48 percent of nurses said medication errors are most likely to occur during the preparation or administering of medication; 47 percent revealed that they’re most likely to occur during the transcription of the initial order.

“Among the contributing factors to medication errors, the fact that they’re too busy or too rushed was the number-one response from nurses (78 percent),” Hughes added. “Some of the others were illegible handwriting (68 percent), similar drug names (56 percent) and working with too many medications (60 percent).”

Adding to the sentiment that they’re often too busy or rushed, 81 percent of nurse respondents said their facility should ensure the availability of sufficient staff in order to reduce the likelihood of injectable medication errors.

Reporting on their practices with injectable medications and syringe labeling, 44 percent of nurses said they inject medicine via syringe more than five times per shift; 37 percent at least once per shift. More than one-third (37 percent) said their injectable medications are always labeled, but 28 percent said they do not label medications at all.

“Sometimes it’s not convenient to label syringes, and sometimes nurses will write on adhesive or even Post-it notes,” Hughes explained. In fact, 54 percent of respondents said they used self-adhesive labels, 31 percent use tape, 11 percent write directly on the syringe with a marker and 4 percent reported using paper or a sticky note. Only half of respondents were aware of the Joint Commission’s determination that pre-labeling of syringes does not meet the labeling goals because the label should be prepared at the time the medication is prepared.

Hughes added that the 2007 study is a follow-up survey to a 2001 health and safety survey, which, in addition to injectable medication safety, covers other workplace issues.

“It’s very interesting that we are still seeing the top safety concerns that we saw in 2001,” she said. “Needle sticks are still a concern, along with stress and overwork, as well as back injury. Plus, 65 percent of nurses said that safety influences their decision on where to work. That’s a message to health care organizations that they really have to look at making a safe workplace for nurses, because what’s beneficial to the nurse is beneficial to the patient.”

Hughes concluded that ANA is a vocal proponent of the use of safety syringes through its “Safe Needles Save Lives” initiative. Nurses, she asserted, must be aware of their facilities’ policies on needle sticks and the products available to reduce the likelihood of injury, and must be involved in the decision making with regard to what products to purchase—and then to use regularly—on their units.