An Adapter-based Safety Injection System with Key and Keyhole Pattern for Prevention of Wrong-route and Wrong-patient Medication Errors

Abstract

Wrong–route or –patient medication errors due to human mistakes have been considered difficult to resolve in clinical settings. In this study, a safety injection system is suggested, which can help to prevent an injection when a mismatch exists between the drug and route or patient. For this, two distinct adapters with key and keyhole patterns specifically assigned to a pair of drug and route or patient were prepared. When connected to a syringe tip and its counterpart, a catheter injection–port, respectively, the adapters allowed for a seamless connection only with their matching patterns. In this study, each of the adapters possessed a specific key and keyhole pattern at one end and the other end was shaped to be a universal fit for syringe tips or catheter injection–ports in clinical use. With the scheme proposed herein, this system could generate 27,000 patterns, depending on the location and shape of the key tooth in the adapters. With a rapid prototyping technique, multiple distinct pairs of adapters could be prepared in a relatively short period of time and thus, it can be envisioned that a specific adapter pair can be produced on–site after patient hospitalization, much like patient identification barcodes.