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The Codonics Safe Labeling System(™) (http://www.codonics.com/Products/SLS/flash/) is a piece of equipment that is able to barcode scan medications, read aloud the medication and the concentration and print a label of the appropriate concentration in the appropriate colour code. We decided to test this system in our facility to identify risks, benefits and usability. Our project comprised a baseline survey (25 anaesthesia cases during which 212 syringes were prepared from 223 drugs), an observational study (47 cases with 330 syringes prepared) and a user acceptability survey. The baseline compliance with all labelling requirements was 58%. In the observational study the compliance using the Codonics system was 98.6% versus 63.8% with conventional labelling. In the user acceptability survey the majority agreed the Codonics machine was easy to use, more legible and adhered with better security than the conventional preprinted label. However, most were neutral when asked about the likelihood of flexibility and customisation and were dissatisfied with the increased workload. Our findings suggest that the Codonics labelling machine is user-friendly and it improved syringe labelling compliance in our study. However, staff need to be willing to follow proper labelling workflow rather than batch label during preparation. Future syringe labelling equipment developers need to concentrate on user interface issues to reduce human factor and workflow problems. Support logistics are also an important consideration prior to implementation of any new labelling system. [ABSTRACT FROM AUTHOR]

Objectives: Our study aims to investigate the safety and efficiency of the Codonics Safe Label System (SLS) in a prospective simulation study., Methods: Three sets of simulated experiments involving 82 anesthetists were carried out on patient simulator mannequins. The primary outcome assessed through the simulated experiments was the effectiveness of the SLS in avoiding vial swap errors. Secondary outcomes analyzed included the efficacy of the SLS in preventing syringe swap and the difference in time taken to prepare standardized drugs as compared with conventional methods., Results: The SLS was associated with a significant reduction in all 4 stages of vial swap error. The incidence of wrong ampoule breakage was significantly lower in the SLS group compared with the conventional group (12.1% versus 38.5%, P = 0.007). The number of staff who drew the wrong ampoule was similarly lower in the SLS group compared with the conventional group (4.9% versus 33.3%, P = 0.001). The proportions of staff who eventually wrongly labeled the loaded syringe were 0% in the SLS group and 17.9% in the conventional group (P = 0.005).Drug preparation time was longer for the SLS group than for the conventional group (239.6 ± 45.9 versus 160.3 ± 46.5 seconds, P < 0.001).There was no significant difference in the incidence of syringe swap with the use of the SLS., Conclusions: The use of the SLS is effective in reducing vial swap error, but not syringe swap errors, and is associated with increased time taken for anesthetic drug preparation., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Adverse events (AEs) remain a challenge in tertiary healthcare with incidence rates of 4% to 14%, where half are potentially preventable. Reported patient safety strategies rarely involve changing the practices of an entire academic institution and maintaining sustainability. We hypothesize that implementing an effective patient safety strategy (PSS) improves hospital-wide AE rates, cost avoidance, and patient safety culture., Methods: A 3-stage hospital-wide PSS was implemented from 2012 to 2016, involving a top-down, bottom-up approach in a 1171-bed academic institution. The primary outcome was the incidence, preventability, and severity of hospital-wide AEs, calculated through the Institute of Healthcare Improvement, Global Trigger Tool method (incidence), National Coordinating Council for Medication Error Reporting and Prevention tool (severity), and a preventability decision algorithm (preventability). Secondary outcomes include hospital-wide cost savings and patient safety climate survey results., Results: A total of 15,120 random chart reviews were performed across 430,868 admissions from 2012 to 2018. Overall, AE rates decreased from 11.6% to 5.4% (R2 = 0.71, P = 0.017). The incidence of preventable AEs declined from 5.7% to 2.0% (R2 = 0.80, P = 0.006). The severity of AEs reduced, with the proportion of category G, H, and I AEs decreasing from 8.4% (2012) to 2.6% (2018). A total of 15,960 hospital-wide patient safety climate surveys were administered from 2011 to 2016, demonstrating an improvement in hospital-wide percentage positive patient safety grade from 46.5% pre-PSS to 58.3% post-PSS implementation. This was accompanied by an 82% increase in voluntary event reporting, and cost savings of 20,600 bed-days and U.S. $29.2 million upon completion of stage 3 (2012-2016)., Conclusions: The hospital-wide PSS resulted in significant improvements in the incidence and severity of AEs, healthcare cost savings, and patient safety culture, demonstrating sustainability for 7 years., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Lung separation may be achieved through the use of double lumen tubes or endobronchial blockers. The use of lung separation techniques carries the risk of airway injuries which range from minor complications like postoperative hoarseness and sore throat to rare and potentially devastating tracheobronchial mucosal injuries like bronchus perforation or rupture. With few case reports to date, bronchial rupture with the use of endobronchial blockers is indeed an overlooked complication., Case Presentation: A 78-year-old male patient with a left upper lobe lung adenocarcinoma underwent a left upper lobectomy with a Fuji Uniblocker® as the lung separation device. Despite an atraumatic insertion and endobronchial blocker balloon volume within manufacturer specifications, an intraoperative air leak developed, and the patient was found to have sustained a left mainstem bronchus rupture which was successfully repaired and the patient extubated uneventfully. Unfortunately, the patient passed on in-hospital from sepsis and other complications., Conclusion: Bronchial rupture is a serious complication of endobronchial blocker use that can carry significant morbidity, and due care should be exercised in its use and placement. Bronchoscopy should be used during insertion, and the volume and pressure of the balloon kept to the minimum required to prevent air leak. Bronchial injury should be considered as a differential in the presence of an unexplained air leak., (© 2021. The Author(s).)