When the International Medication Safety Network (IMSN) meets in Toronto on October 24, 2016, for the 2016 IMSN Global Regulatory Meeting, delegates from 27 member countries, the World Health Organization (WHO) and invited regulators will share their views and concerns on labelling, packaging and nomenclature issues prone to medication errors at a global level.

Mr. Wu Tuck Seng, Chairperson of the National Medication Safety Committee, Ministry of Health, and Deputy Director and Head of the Pharmacy Department, National University Hospital in Singapore will be closely following discussions on how to use technology and automation to improve medication safety, specifically bar-coding. Currently, bar-coding of medications is not mandatory in Singapore. They are working towards establishing national compliance, if possible, similar to that in the United States.

"I want to find out more about bar-coding; the strategies we can employ, what are the challenges, and how we can implement bar-coding at a national level for all drugs," says Mr. Wu. "I want to know how others have worked with the pharmaceutical manufacturers to address bar-coding and medication safety."

When it comes to medication safety and medication errors, Singapore uses the root cause analysis methodology to look at what happened, why it happened and what they can do to prevent similar medication errors in the future from a people, process and system perspective. "The majority of medication errors occur at the prescribing and drug administration stage rather than at dispensing," says Mr. Wu. "We need to better understand the opportunities for errors, and learn from our near misses and mistakes and how we can improve our systems, process and people holistically. Healthcare providers can provide insight about where things go wrong before they go wrong. The drugs we use now are more potent and sophisticated. Hence, we need to exercise vigilance even more and involve and work with the staff that are storing, preparing, and administering the drug."

Mr. Wu says that the medication errors they commonly see are a combination of the wrong dilution, wrong concentration or the wrong dose being administered. To mitigate this, Singapore hospitals have been using premixes where available. They have been trying to get heparin in pre-mixed doses, but to date, have not been successful.

Medication errors involving opioid drugs directly relates to how they are drawn into the syringe and then administered. An ampoule of morphine injection typically contains 10mg. Often times, the prescribed dose is less. For example, if 5mg is needed, only half the volume should be drawn up into the syringe. However, the usual practice is such that the nurse/doctor will draw up the entire 10mg dose into the syringe, and before drug administration the volume not required would be squirted out before the injection. Unfortunately, invariably another staff that is told to administer the medication fails to check the dose or expects the dose to be correct and mistakenly administers 10 mg instead of 5 mg. "This is a practice and process problem, not a drug concentration problem.  The objective is to ensure they only administer what is prescribed," says Mr. Wu.

For insulin safety, one hospital in Singapore has developed an insulin vial cap device that fits over the insulin vial. Once attached, it cannot be removed. This cap only allows you to use insulin syringes to draw out the insulin from the vial. It will not allow the use of non insulin syringes. This is a forcing function. The device costs approximately $20 per unit in Singapore currency ($20 CDN).

The IMSN Global Regulatory Meeting agenda will address manufacturer labelling and look-alike/sound-alike drugs. The IMSN is working with the WHO to develop an international naming nomenclature to address this. "These are important issues pertaining to medication safety that continue to confront us," says Mr. Wu. "We can mitigate medication errors by introducing specific nomenclature for look-alike/sound-alike drugs besides labelling and packaging that can better differentiate them."