The safe administration of drugs is a key area in anaesthesia and intensive care. Ensuring patients receive the correct dose of the correct drug requires great care during the drawing up process (with any dilution required) and appropriate drug labelling. The anaesthetist must always remain vigilant for adverse drug reactions including anaphylaxis. Some of the drugs classes encountered maybe familiar to novices (such as opioids and some sedatives, antibiotics) but others will be less familiar (especially intravenous and volatile anaesthetic agents, both depolarising and non-depolarising neuromuscular blocking drugs, and nitrous oxide). Anaesthetists are often required to administer other drugs such as antibiotics, drugs affecting coagulation and drugs to assist imaging.

New areas are discussed, such as the transition away from nitrous oxide, desflurane and suxamethonium and the widespread use of sugammadex to reverse rocuronium, as well as the choice of total intravenous anaesthesia (TIVA) or volatile-based anaesthesia.

Many nurses will be asked to give evidence at a coroner’s inquest during their nursing career. Being asked to give evidence can feel incredibly daunting and generate complex feelings. It’s important to remember that the coroner is looking for your help with the inquiry. The coroner can also seek an expert opinion by a nursing professional on the care of the person who has died. This chapter provides advice on how best to fulfil your duty.

Medication errors are believed to be a leading cause of avoidable harm to patients around the world, with an estimated cost of US$42 billion per year, worldwide. It has been estimated that 5% of all patients who are admitted to a hospital experience a medication error, and that an average hospital will have one medication error every 22.7 hours or every 19.7 admissions. Human error is inevitable, but many of these errors actually reflect failures in the design and resourcing of the system within which medications are administered to patients, and some reflect violations of safe medication practices. Medication errors are the most common of all medical errors and pose a tremendous emotional and physical cost to patients and economic burden to our health system. Clearly medication error is a major source of risk and adverse events for our patients. This chapter presents a roadmap for the rest of the book, and definitions that will be used throughout. We also discuss how medication error is measured, the methods by which it is studied, the techniques used to capture incident reports, and some of the metrics and statistics to report these errors and incidents.