ERCP-Quality Network

Over the last decade there has been increasing interest in quality issues in Endoscopy. The GRS has served to drive up the quality of service and there is ongoing work under the auspices of JAG to derive a framework for quality assurance of individual Endoscopists. What has been lacking hitherto is an infrastructure to facilitate collection and analyses of data to allow practitioners to compare themselves with others ("benchmarking").

National Patient Safety Agency Rapid Response Report Issued: Reducing risk of overdose with midazolam injection in adults

Some adult patients are being overdosed with midazolam injection when used for conscious sedation. The presentation of high strength midazolam as 5mg/ml (2ml and 10ml ampoules) or 2mg/ml (5ml ampoule) exceeds the dose required for most patients. There is a risk that the entire contents of high strength ampoules are administered to the patient when only a fraction of this dose is required. Doses often exceed that required, are not titrated to the patient’s individual needs, do not take into account concurrent medication (e.g. opioids) and may involve high risk groups for example, the frail or the elderly. There is frequent reliance on injectable flumazenil (antagonist/reversing agent) for reversal of sedation in patients that have been over sedated.

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Reducing risk of overdose

[Reducing risk of overdose with midazolam injection in adults ]

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