Patient safety

Introduction of safer spinal and epidural devices to improve patient safety

24 November 2009

A new patient safety alert issued to NHS health-care organizations in England and Wales aims to minimize the risk of wrong-route medication administration errors resulting in severe harm and death. The NHS will become the first health-care system in the world to implement medical devices with safer designs for spinal, epidural and regional anaesthesia use.

WHO Patient Safety Chair Sir Liam Donaldson said 'Wrong-route medication administration incidents are rare events, but they have occurred with utterly tragic and fatal consequences'.

The alert was developed using an expert reference group chaired by Professor Brian Toft, of which WHO was a member. The alert was published in collaboration with the 30 health-care, commercial and governmental organizations which comprise the NPSA External Reference Group for Safer Neuraxial Devices. Read more below.