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estimating and reporting rates, and detecting improvements

Whitaker, David

European Journal of Anaesthesiology (EJA): January 2018 - Volume 35 - Issue 1 - p 61
doi: 10.1097/EJA.0000000000000598

From the Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK (DW)

Correspondence to David Whitaker, FRCA, FFPMRCA, FFICM, FCARCSI (Hon), Department of Anaesthesia, Manchester Royal Infirmary, Manchester, M13 9WL, UK Tel: +44 161 276 4551; fax: +44 161 276 8027; e-mail:


We are grateful to Dr Webster for his letter1 in connection with our article on the European Board of Anaesthesiology (EBA) Medication Guidelines First update.2 His detailed clarification about the estimating and reporting of error rates is particularly useful. We congratulate his group on their original study3 and continuing work on this important issue.

We agree with his comments about observational studies but would mention another by Yang et al.4 that looked at Human Factors associated with Medication Delivery during anaesthesia and showed that prefilled syringes are superior to self-filled syringes in terms of the simplified work processes and the reduced number of system violations and associated risks. The EBA guidelines already recommend that prefilled syringes should be used whenever possible.

It is also reassuring that his group's accurate data from a recent study has produced evidence of significant safety benefits with the use of the international ISO 26286 coloured coded labels5 reducing the more harmful between-class drug errors, another recommendation from the EBA guidelines.

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Acknowledgements relating to this article

Assistance with the reply: all members of the European Board of Anaesthesiology.

Financial support and sponsorship: none.

Conflicts of interest: DW has lectured on medication safety, but all the fees for these activities have been donated to the charity Lifebox.

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1. Webster CS. Estimating and reporting error rates, and detecting improvements. Eur J Anaesthesiol 2018; 35:60–61.
2. Whitaker D, Brattebo G, Trenkler S, et al. The European Board of Anaesthesiology recommendations for safe medication practice. Eur J Anaesthesiol 2017; 34:4–7.
3. Webster CS, Merry AF, Larsson L, et al. The frequency and nature of drug administration error during anaesthesia. Anaesth Intensive Care 2001; 29:494–500.
4. Yang Y, Rivera AJ, Fortier CR, et al. A human factors engineering study of the medication delivery process during an anesthetic: self-filled syringes versus prefilled syringes. Anesthesiology 2016; 124:795–803.
5. Webster CS, Larsson L, Frampton CM, et al. Clinical assessment of a new anaesthetic drug administration system: a prospective, controlled, longitudinal incident monitoring study. Anaesthesia 2010; 65:490–499.
© 2018 European Society of Anaesthesiology