The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Letter to the Editor
Editor, – I have major concerns about Ropivacaine Sandoz, which has appeared in several private hospitals.
This product is labelled ropivacaine 150 mg/20 mL. Nowhere on the packet or the ampoule does it say that this is equivalent to 0.75% ropivacaine, or 7.5 mg/mL. When ropivacaine was first marketed about ten years ago it was marketed as 2 mg/mL, 7.5 mg/mL or 10 mg/mL strengths. More recently this was changed to percent labelling (0.2%, 0.75% and 1%) to make it consistent with all the other available local anaesthetics.
My concern is that nowhere on the packaging does it say that this is 0.75% ropivacaine or 7.5 mg/mL. It only has the total amount of milligrams in the bottle.
This is a great potential source of confusion and particularly if ropivacaine is being used on the ward. Many nurses have expressed to me their confusion when looking for the requested local anaesthetic.
I think the labelling is inadequate and unsafe. It is clearly a potential source of medication error.
Calvary Wakefield Hospital
Letter to the Editor
Editor, – There are two aspects of prescriptions that can cause problems to patients, pharmacy staff and doctors.
Firstly, repeat authorisation forms are confusing – all the information is there, but there are three boxes of information for the patient. Number of repeats remaining is sometimes not interpreted correctly, perhaps because the ‘Number of supplies left’ line is overshadowed by the bar code and the patient only reads the information in the two boxes above.
Patients ask for a repeat prescription when there is still one repeat outstanding, or are occasionally directed by pharmacy staff to ask for a repeat. If the form was altered so that it stated (1) the original prescription details – and put in the total number authorised (not just repeats), and (2) the number of supplies left – and leave the space for the bar code free, I think there would be no confusion.
Secondly it is frustrating, and potentially dangerous for patients that the highlighted name on dispensed medications and the repeat prescription is the trade name, with the generic name in smaller print.
We used to know the trade names, but now there are so many it is impossible to know them all. For prescribers, it is a time consuming process to try to work out what is being requested – and the worst situation by far is the Webster pack system. It is dangerous for patients. For example, recently a patient was taking the same medication twice because of different trade names.
It would be safer and so much more logical if the large print name was the generic name and the trade name was in smaller print.
- Wheeler SJ, Wheeler DW. Dose calculation and medication error - why are we still weakened by strengths? Eur J Anaesthesiol 2004;21:929-31.
- Simpson CM, Keijzers B, Lind JF. A survey of drug-dose calculation skills of Australian tertiary hospital doctors. Med J Aust 2009;190:117-20.
- Garnerin P, Perneger T, Chopard P, Arès M, Baalbaki R, Bonnabry P, et al. Drug selection errors in relation to medication labels: a simulation study. Anaesthesia 2007;62:1090-4 .