Top parenteral gentamicin safety messages (Adults)
The following key messages have been drafted in response to learning from gentamicin incidents in NHSGGC and should be followed to ensure this medicine is given safely and appropriately.
Key messages for prescribers and nurses
- Avoid parenteral gentamicin in patients with decompensated liver disease or myasthenia gravis.
- Only use the NHSGGC gentamicin calculator on Clinical Info or the GGC Medicines App to obtain the initial dose and enter the details carefully – recent DATIX reports have highlighted errors in data entry (wrong sex, wrong height/weight, wrong creatinine, data entered in incorrect box) leading to dosing errors.
- Check if the patient has already received a gentamicin dose recently elsewhere (e.g. in A&E, receiving, theatres) before prescribing/administering - failure to do this has resulted in patients receiving multiple doses in a short timeframe.
- Check for signs of gentamicin toxicity (particularly renal and oto/vestibular toxicity) before prescribing each dose. Nurses should report any signs of toxicity to medical staff immediately (the signs of toxicity are detailed on the prescribing chart).
- Prescribe gentamicin ‘as per chart’ on the drug kardex – do NOT add dose amounts/times on the kardex as this causes confusion and errors if these change.
- Issue the gentamicin patient information leaflet at the time of prescribing – this is attached to the prescribing chart and helps patients recognise and report signs of toxicity.
- Complete and print TrakCare requests for gentamicin levels at the time the sample is taken – this ensures electronic sample times are reliable and that blood levels can be interpreted accurately.
- Record the time of gentamicin samples accurately on the gentamicin chart.
- Do NOT prescribe gentamicin in advance of the day the dose is due – this leads frequently to errors, where the dose is given on the wrong day. When prescribing 48 hourly dosing write ‘no dose required’ on the days when this applies (see here for prescribing advice).
- Gentamicin should not normally be used for longer than 4 days to avoid toxicity – refer to GGC guidance if Gram-negative cover is still required after this time. Remember, for those on 48 hourly dosing the 4 days will comprise of only 2 doses.
Additional key messages for nursing staff
- Check the date and time of the prescribed dose carefully before administering – failure to do this has resulted in gentamicin doses being given a day early.
- Check the medicine kardex before administering gentamicin to ensure that it has not been discontinued there – administration should be documented on both the kardex and the gentamicin chart in case the chart is misplaced.
- Record gentamicin administration times accurately on the prescribing chart – this ensures that blood levels can be interpreted accurately.
Published 30/06/2021. Links updated 23/02/22 and again 01/08/24. Medicines update blogs are correct at the time of publication.