INJECTION SAFETY When prepared in syringes, Exparel and propofol essentially look identical. They're also similarly packaged.

It's easy to see how you could mistake propofol for Exparel (bupivacaine liposome). Not only are some vials both teal-colored, but the milky-white suspensions also look nearly identical when prepared in syringes. But mistaking one for the other could result in serious patient harm, according to an alert from the National Medication Errors Reporting Program. Here's how to avoid this dangerous drug mix-up.

Exparel not meant for IV
Exparel is a new local anesthetic that is infiltrated into surgical wounds to produce post-surgical analgesia. It is not meant for IV administration. If you accidentally administer Exparel intravenously instead of propofol, toxic blood concentrations might result, and cardiac conductivity and excitability may be depressed, which may lead to atrioventricular block, ventricular arrhythmias and cardiac arrest, according to the alert.

You've long heard drug safety experts say that similar-looking drug vials and unlabeled syringes commonly cause medication errors. Now that propofol is no longer the only white emulsion in the surgical setting, any unlabeled syringe is an extremely dangerous proposition.

More potential for wrong route errors with Exparel: The drugs are similarly packaged. Exparel's teal-and-white package resembles some propofol vials, and the 20ml volume of Exparel vials is similar to that of some propofol vials.

Safety steps you should take
If your facility stocks both propofol and Exparel, the drug safety alert suggests you:

Divide and conquer. Stock propofol and Exparel vials in separate areas to avoid confusion.

Label all syringes. Remind staff to never leave any syringe of medication or solution unlabeled. In the OR or in other surgical areas where Exparel and propofol may both be used, all syringes of these medications prepared by a scrub nurse, circulating registered nurse, anesthesia staff or surgeon should be labeled, even if the medication will be immediately administered (propofol) or infiltrated into the surgical site (Exparel).

Safeguard unused Exparel. The circulating nurse should double-check to be sure any unused medication in a syringe containing Exparel never leaves the sterile field without a label.

Be prepared to treat toxicity. Post directions for the treatment of bupivacaine toxicity in all surgical areas where Exparel may be used. You can download a checklist for the treatment of local anesthetic system toxicity at the American Society of Regional Anesthesia and Pain Medicine's website (www.asra.com).