Epidural Label Safety Checklist Instructions

Completing the checklist

1. It is recommended that the Epidural Label Safety Checklist be completed by an interdisciplinary team. Suggested minimum team composition for hospitals:

  • staff nurses from obstetrics, surgical and post-anaesthetic care units
  • staff pharmacist (with expertise in obstetrics and post-anaesthesia care, if available)
  • pharmacy technician involved in preparation and labelling of epidural medications
  • supervisory nurse
  • supervisory pharmacist

Additional suggested team members:

  • physician with expertise in anaesthesia
  • quality improvement advisor/ patient safety officer/ risk manager
  • leadership representative

Team composition will vary in non-hospital settings such as specialty pharmacies and manufacturers; however, should include a mix of frontline and supervisory staff.

2. Distribute the checklist before the team meeting so that team members can review and consider the questions in advance. The copyright allows you to make copies of the checklist for internal use.

3. Complete the "Demographic Information" section.

4. Discuss each self-assessment item and evaluate the organization's current success in implementing the item. As necessary, investigate and verify the level of implementation for each item with other healthcare practitioners outside the team.

  1. A There has been no activity to implement this item for any epidural labels
  2. B This item has been formally discussed but not implemented for any epidural labels
  3. C This item has been partially implemented for some epidural labels or in some areas of the organization
  4. D This item is fully implemented for all epidural labels in some areas of the organization.
  5. E This item is fully implemented for all epidural labels throughout the organization.

5. Submit data from the completed self-assessment to ISMP Canada electronically through our secure web site.

The web-based survey tool will immediately download the information into a database maintained solely by ISMP Canada. No data is maintained on the Internet survey form after it has been submitted. Confidentiality is assured. The aggregate findings may be used by ISMP Canada for research and education purposes.

The web-based program will allow you to compare your results with those of other respondents. To protect the privacy of individual respondents, there must be at least 3 sites in the selected dataset to perform a comparison. Over time, you will be able to complete repeat assessments and compare your own results from one assessment to the next.