The American Society of Health-System Pharmacists (ASHP) and the Institute for Safe Medication Practices (ISMP) are warning that the current shortage of pre-filled EPINEPHrine emergency syringes could result in serious medication errors. Problems can occur when users attempt to replace the 1 mg/10 mL syringes by diluting a more concentrated form of the drug from an ampul or vial.

ASHP and ISMP give several recommendations to help avoid errors during the shortage:

• Reserve current supplies of EPINEPHrine emergency syringes for code boxes and situations where pharmacists will not be present to dilute solutions during a code situation.

• If using 1 mg/1 mL ampuls or vials instead of emergency syringes, package the vial, the diluent, and the syringe label in a clear plastic bag that’s labeled with the drug name and strength. Include instructions on preparing a dilution that is equivalent to a prefilled 1 mg/10 mL emergency syringe.

• Do not stock multiple-dose 30 mL vials of injectable EPINEPHrine 1 mg/mL in code boxes. These vials look similar to the 30 mL vials of topical EPINEPHrine that may also be stocked in code boxes or used in the OR.

• Place auxiliary labels on EPINEPHrine emergency syringes that have an intracardiac syringe, warning against intravenous and endotracheal use. Caution practitioners about possible injury if they try to remove the fixed needle.

• Finally pharmacists should let practitioners know about the shortage and recommend appropriate substitute products.